Comparison of the Effect of Pyridostigmine and Sugammadex on Emergence Delirium in Pediatric Patients Undergoing

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Chung-Sik Oh1,2,3, Hyun Jin Shin2,3,4, Seon-Ju Park1

  • 1Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul 05030, Republic of Korea.

Journal of Clinical Medicine
|August 13, 2026
PubMed

Insights

Emergence delirium (ED) in pediatric patients after anesthesia was similar whether pyridostigmine or sugammadex was used for reversal. Neither agent significantly impacted ED incidence or severity in strabismus surgery patients.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Emergence delirium (ED) is a frequent complication in children post-general anesthesia.
  • Reduced cholinergic neurotransmission is linked to cognitive deficits and increased delirium risk.
  • Pediatric strabismus surgery is a common procedure where ED can occur.

Purpose of the Study:

  • To compare the incidence of ED after using a cholinesterase inhibitor (pyridostigmine) versus sugammadex for neuromuscular blockade reversal.
  • To evaluate the impact of different neuromuscular reversal agents on ED in pediatric patients undergoing strabismus surgery.

Main Methods:

  • A randomized study involving 76 pediatric patients (aged 4-7 years) undergoing strabismus surgery.
  • Patients were allocated to receive either pyridostigmine (Group P) or sugammadex (Group S) for neuromuscular blockade reversal.
  • The Pediatric Anesthesia Emergence Delirium (PAED) scale was used to assess ED, defined as a score ≥ 10.

Main Results:

  • The incidence of ED was 50.0% in the pyridostigmine group and 40.5% in the sugammadex group (p=0.417).
  • Peak PAED scores were not significantly different between the two groups (p=0.277).
  • The study included 73 patients who completed the assessment.

Conclusions:

  • The choice of neuromuscular reversal agent (pyridostigmine vs. sugammadex) did not significantly alter the incidence or severity of emergence delirium.
  • These findings suggest that current reversal strategies do not differentially impact ED in this pediatric population undergoing strabismus surgery.

Keywords:
anesthesiaemergence deliriumgeneralneuromuscular blockadeophthalmicpediatricsstrabismussurgical procedure

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