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Incidence and Risk Factors of Emergence Delirium in Children Undergoing Orthopedic Surgery: A Secondary Analysis of
Yi-Chen Chen1, Jann Foster2, Man-Ling Wang3
1School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing and Midwifery, Western Sydney University, Penrith, Australia.
Insights
Emergence delirium (ED) affects nearly half of children post-anesthesia, with hyperactive ED being most common. Hypoactive ED, though less frequent, lasts longer, highlighting the need for vigilant monitoring in pediatric orthopedic surgery.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Surgery
- Neuroscience
Background:
- Emergence delirium (ED) is a common postanesthetic complication in children, characterized by altered awareness and behavior.
- While hyperactive ED is well-studied, the hypoactive subtype is under-recognized despite its prevalence in pediatric surgeries.
- ED in orthopedic surgery requires further investigation regarding subtype prevalence and risk factors.
Purpose of the Study:
- To investigate the incidence and characteristics of emergence delirium subtypes in pediatric orthopedic surgery.
- To identify risk factors associated with pediatric ED in the postanesthesia care unit (PACU).
Main Methods:
- An observational, cross-sectional study analyzed secondary data from 200 children.
- Cornell Assessment of Pediatric Delirium (CAPD-TC) evaluated ED in the PACU.
- Binary logistic regression identified factors associated with ED.
Main Results:
- ED incidence was 48.0% upon PACU arrival, decreasing over time.
- Hyperactive ED comprised 80.2% of cases, while hypoactive ED accounted for 17.7%.
- Hypoactive ED had a significantly longer duration (21.5 min) than hyperactive ED (10.1 min).
- Postoperative pain and laryngeal mask airway use were associated with ED.
Conclusions:
- High ED incidence necessitates recognizing associated factors and optimizing clinical resource allocation.
- Clinicians must monitor vital signs, consciousness recovery, and associated risks, considering both ED subtypes.
- Understanding ED subtypes and risk factors is crucial for effective pediatric postanesthetic care.
Background:
Emergence delirium (ED) is a postanesthetic phenomenon more frequently observed in children, typically presenting as altered awareness and behavioral disturbances. While research has primarily focused on the hyperactive subtype of ED, emerging evidence highlights the under-recognized hypoactive subtype. Despite its high occurrence in various pediatric surgeries, ED in orthopedic contexts remains insufficiently studied, particularly regarding subtype characteristics and associated risk factors.
Design:
Observational, cross-sectional study involved secondary data analysis.
Methods:
A total of 200 children were included. ED was evaluated on the basis of the Traditional Chinese version of the Cornell Assessment of Pediatric Delirium (CAPD-TC) while patients were in the postanesthesia care unit (PACU). Factors associated with pediatric ED were examined through binary logistic regression analysis.
Results:
ED incidence was 48.0% on arrival in the PACU and subsequently decreased over time. Among the ED cases, 80.2% were hyperactive and 17.7% were hypoactive. The duration of hypoactive ED was significantly longer than that of hyperactive ED (median: 21.5 vs 10.1 min, P = 0.003). Postoperative pain (odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.03 to 1.43) and laryngeal mask airway use under general anesthesia (OR = 3.03, 95% CI: 1.47 to 6.26) were significantly associated with CAPD-TC-positive ED symptoms after adjustment for covariates.
Conclusions:
The high incidence of ED on arrival in the PACU underscores the necessity of recognizing factors associated with ED and effectively allocating clinical resources. Hyperactive ED was the most common ED subtype, although the hypoactive subtype was characterized by a longer duration. These findings indicate that clinicians should monitor vital signs as well as consciousness recovery and associated risks.
