Emergence Delirium in Paediatrics Explained

emergence delirium paediatric anaesthesia paediatrics recovery issues Sep 18, 2023

Emergence delirium (ED) is transient state of irritation and confusion after the cessation of general anaesthesia 😳

It is one of the most common causes of postoperative agitation. One distinct feature is that the child does not recognise the parent or respond to consoling measures. Although it’s common, that doesn’t mean it is without risk 💥

Here's what you need to know 👇
Risk factors for ED:

1️⃣ Patient
👉 Age 2-5
👉 Preoperative anxiety
👉 Personal history of ED
2️⃣ Anaesthetic
👉 Rapid emergence
👉 Short acting volatile agents (sevoflurane, desflurane)
👉 Stormy induction
3️⃣ Surgical
👉 Surgery on the eyes, ears, throat, nose.
👉 High pain levels

Prevention:
👉 Premedication
👉 Calm induction
👉 Good perioperative analgesia
👉 TIVA
👉 Propofol bolus/infusion at end of surgery
👉 Intraoperative ketamine, fentanyl, clonidine, dexmedetomidine

Management:
1️⃣ Eliminate causes of agitation: hypoxia, pain, hypo/hyperthermia, hunger, bladder distension
2️⃣ Protect the child from self-inflicted injury
3️⃣ Reduce stimuli if possible, such as noise, light and handling
4️⃣ Reassure the parents of self-limiting nature and good prognosis of the condition
5️⃣ If severe, consider rescue medication with propofol (0.5-2mg/kg), fentanyl (0.5-1mcg/kg) or clonidine (0.5-1mcg/kg).

Now you’re ready to anticipate, prevent and manage emergence delirium 🥳🤩

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