Emergence Agitation

2013 ◽  
Author(s):  
Charles B Eastwood ◽  
Paul J Samuels
Keyword(s):  
Patient Safety ◽  
Pediatric Anesthesia ◽  
Medication Administration ◽  
Parental Satisfaction ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Emergence Agitation ◽  
Urinary Catheters ◽  
Emergence Delirium ◽  
Present Understanding

Emergence delirium is a common and challenging post-anesthetic complication in children characterized by a brief period of inconsolability, disorientation, and combativeness. Emergence delirium threatens patient safety due to potential self-injurious behavior or by untimely removal of intravenous lines, urinary catheters, and surgical drains. The economic impact of emergence delirium is a consequence of delayed post-anesthesia care unit (PACU) discharge and the need for additional medication administration and increased PACU staffing. In addition, despite the short duration of emergence delirium, its dramatic and frightening presentation can diminish parental satisfaction. Although no consistently effective treatment for emergence delirium has been described, familiarity with this clinical entity and approaches to its management and prevention are important to those who provide pediatric anesthesia care. This chapter will focus on our present understanding of emergence delirium in children.

scholarly journals Comparing the effects of propofol and ketamine on the emergence agitation of male children undergoing circumcision

2022 ◽  
Vol 18 (1) ◽  
Author(s):  
Ayşenur Sümer Coşkun
Keyword(s):  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Emergence Agitation ◽  
Point Scale ◽  
Bodily Integrity ◽  
Inhalational Anesthesia ◽  
Significant Difference ◽  
The Family ◽  
Safe Anesthesia ◽  
Made In

Abstract Background Separation from the family, prolonged hunger, inability to perceive the surgical procedure performed, and feeling pain are among the main reasons for agitation in young children. In operations like circumcision, in which all bodily integrity is disrupted and children cannot make sense of it and feel punished, this agitation increases. The aim of the present study was to compare the effects of propofol and ketamine on the emergence agitation (EA) in children undergoing circumcision. Result When the patients were taken to post-anesthesia care unit (PACU), no statistically significant difference was observed between propofol and ketamine groups in the Aono’s four-point scale at minute 0 (p = 0.073). In the 5th minute, it was higher in the ketamine group compared to the propofol group (p < 0.001). With Aono’s four-point scale, EA diagnosis is made in areas with 3 and 4 points. The average Aono’s four-point scale in the ketamine group at the 5th minute was 3.08 ± 1.02. Since the Modified Steward score was ≥ 6, the time taken was longer in the ketamine group compared to the propofol group (p < 0.001). Conclusion EA does not only occur in inhalational anesthetics, it is also seen with ketamine. In view of the fact that ketamine can cause EA in children, it should not be used alone in anesthesia. Propofol provides a safe anesthesia. Instead of inhalational anesthesia, where the type of surgery is suitable, anesthesia with propofol infusion should be applied. Further research is required to investigate EA.

scholarly journals Prophylactic premedication can reduce Emergence Agitation after Sevoflurane Anesthesia in Pediatrics: A placebo-controlled prospective trial.

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
Amir Abouzkry ◽  
Sherif Arafa
Keyword(s):  
Prospective Trial ◽  
Pediatric Anesthesia ◽  
Anesthesia Care ◽  
Sevoflurane Anesthesia ◽  
Emergence Agitation ◽  
Web Based ◽  
Risk Of Injury ◽  
Children And Parents ◽  
Increased Risk ◽  
Inhaled Anesthetic

Sevoflurane is an inhaled anesthetic widely used for pediatric anesthesia, but emergence agitation (EA) or emergence delirium (ED) is a common sevoflurane anesthesia recovery-associated problem.1 Emergence agitation is associated with increased risk of injury in children and parents' dissatisfaction with anesthesia care.2 In a web-based survey of pediatric anesthesiologists in Canadian Pediatric Anesthesia Society, 42% felt that EA was a significant problem and 45% of them were giving medication before or during anesthesia to prevent its development.

scholarly journals The Effect of Dexmedetomidine on Emergence Agitation in Children After Desflurane Anesthesia

Acta Medica ◽  
2018 ◽  
Vol 49 (2) ◽  
pp. 1
Author(s):  
Filiz Banu Ethemoglu ◽  
Aysun Ankay Yilbas ◽  
Basak Akca ◽  
Hemra Cil ◽  
Ozgur Canbay
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pediatric Anesthesia ◽  
Saline Group ◽  
Pain Scale ◽  
Control Group ◽  
Emergence Agitation ◽  
Emergence Delirium ◽  
Significant Difference ◽  
Duration Of Surgery

Objective: To evaluate the effect of dexmedetomidine on the emergence agitation in children after desflurane anesthesia. Materials-Methods: In this prospective  randomized comparative study, 50 children between the age group 2-10 years of American Society of Anesthesiologists physical status  I or II, who were scheduled for infrainguinal urologic surgery were enrolled and randomly divided into two groups. Group dexmedetomidine (Group B) (n=25) received 0.2 μg/kg dexmedetomidine in 10 ml saline intravenously over 10 minutes after induction and group control (Group A) (n=25) received only 10 ml saline infusion after induction. The emergence agitation levels of the children were evaluated according to the Pediatric Anesthesia Emergence Delirium Scale in the recovery room and postoperative pain scores were evaluated using Children’s and Infants’ Postoperative Pain Scale at the 10th and 30th minutes after extubation. Age, gender, weight, hemodynamic parameters, duration of anesthesia, duration of surgery and side effects were recorded.  Results: There was no significant difference in Pediatric Anesthesia Emergence Delirium scores at the 10th and 30th minutes after extubation between dexmedetomidine and saline groups. The decrease in emergence agitation at the 30th minute compared to the 10th minute was independent from sex, age and anesthesia duration in both groups. Incidence of hypotension and bradycardia was higher in the dexmedetomidine group compared to the saline group.  Conclusion: In children aged from two to 10 who undergo surgery with desflurane anesthesia, dexmedetomidine administration was not effective in preventing postoperative emergence agitation and caused increased side effects, such as hypotension and bradycardia. 

scholarly journals Intranasal Dexmedetomidine Accompanied by Cartoon Video Preoperation for Reducing Emergence Delirium in Children Undergoing Strabismus Surgery: A Prospective Randomized Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Liyan Chu ◽  
Yue Wang ◽  
Shanshan Wang ◽  
Shaofei Su ◽  
Zhixing Guo ◽  
...  
Keyword(s):  
Preschool Children ◽  
General Anesthesia ◽  
Parental Satisfaction ◽  
Strabismus Surgery ◽  
Preoperative Anxiety ◽  
Satisfaction Score ◽  
Emergence Agitation ◽  
Discharge Time ◽  
Emergence Delirium ◽  
Separation From Parents

Background: After general anesthesia, many pediatric patients present with emergence delirium (ED). The aim of this study was to determine whether dexmedetomidine intranasal premedication accompanied by a cartoon video 30 min before general anesthesia would have an effect on reducing emergence delirium in preschool children.Methods: One hundred and forty children aged 3–6 year undergoing elective strabismus surgery were randomly to be premedicated with 2 μg kg−1 intranasal dexmedetomidine accompanied by the viewing of a cartoon video (Group DV) or without any premedication as usual (Group C). The primary outcome was the incidence of emergence delirium at the postanesthesia care unit (PACU), evaluated by the Pediatric Anesthesia Emergence Delirium (PAED) scale. The secondary outcomes included: the Modified Yale Preoperative Anxiety Scale (mYPAS) upon separation from parents; the Induction Compliance Checklist score (ICC); the PACU discharge time; the parental satisfaction score; the incidences of the side effects and the Post-Hospital Behavior Questionnaire (PHBQ) score during the first day after surgery.Results: The incidence of emergence agitation (PAED score ≥ 10) was reduced in Group DV compared with Group C [8 (11.4%) vs. 24 (34.3%); P = 0.001]. None of the patients in the DV group experienced severe emergence agitation (PAED score ≥ 15), as compared with the C group (P = 0.006). The mYPAS score upon separation from parents (P &lt; 0.001) and the incidence of poor coordination (ICC ≥ 4) during induction (P &lt; 0.001) were significantly lower in Group DV than in Group C. In Group DV, the PACU discharge time was longer (P &lt; 0.001), and the parental satisfaction score was higher (P &lt; 0.001). However, during the first day after surgery, the PHBQ score was lower in Group DV compared with Group C (P = 0.001).Conclusions: Premedication with 2 μg kg−1 intranasal dexmedetomidine accompanied by cartoon video viewing can dramatically reduce emergence delirium in preschool children undergoing strabismus surgery, relieve preoperative anxiety and improve the parental satisfaction and the postoperative behavior changes during the first day after surgery.Clinical Trial Registration: ChiCTR2000030678.

scholarly journals A Single Dose of Propofol at the End of Surgery for the Prevention of Emergence Agitation in Children Undergoing Strabismus Surgery during Sevoflurane Anesthesia

2007 ◽  
Vol 107 (5) ◽  
pp. 733-738 ◽  
Author(s):  
Marie T. Aouad ◽  
Vanda G. Yazbeck-Karam ◽  
Viviane G. Nasr ◽  
Mohamad F. El-Khatib ◽  
Ghassan E. Kanazi ◽  
...  
Keyword(s):  
Single Dose ◽  
Pediatric Anesthesia ◽  
Saline Group ◽  
Strabismus Surgery ◽  
Postanesthesia Care Unit ◽  
Double Blind Study ◽  
Healthy Children ◽  
Emergence Agitation ◽  
Double Blind ◽  
Emergence Delirium

Background Emergence agitation in children after sevoflurane is common. Different drugs have been used to decrease its occurrence with variable efficacy. The authors compared the incidence and severity of emergence agitation in children who received a single dose of propofol at the end of strabismus surgery versus children who received saline. Methods In this prospective, randomized, double-blind study, the authors enrolled 80 healthy children aged 2-6 yr. The children were randomly allocated to the propofol group (n = 41), which received 1 mg/kg propofol at the end of surgery, or to the saline group (n = 39), which received saline. Results The mean scores on the Pediatric Anesthesia Emergence Delirium scale were significantly lower in the propofol group compared with the saline group (8.6 +/- 3.9 vs. 11.5 +/- 4.5; P = 0.004). Also, the incidence of agitation was significantly lower in the propofol group compared with the saline group (19.5% vs. 47.2%; P = 0.01). A threshold score greater than 10 on the Pediatric Anesthesia Emergence Delirium scale was the best discriminator between presence and absence of emergence agitation. Times to removal of the laryngeal mask airway (10.6 +/- 1.5 vs. 9.4 +/- 1.9 min; P = 0.004) and emergence times (23.4 +/- 5.7 vs. 19.7 +/- 5 min; P = 0.004) were significantly longer in the propofol group. However, discharge times were similar between the two groups (propofol: 34.1 +/- 8.4 min; saline: 34.9 +/- 8.6 min). More parents in the propofol group were satisfied. Conclusions In children undergoing strabismus surgery, 1 mg/kg propofol at the end of surgery after discontinuation of sevoflurane decreases the incidence of agitation and improves parents' satisfaction without delaying discharge from the postanesthesia care unit.

Factors Affecting Post-Anesthesia Care Unit Length of Stay in Pediatric Patients after an Adenotonsillectomy

2020 ◽  
Vol 129 (11) ◽  
pp. 1071-1077
Author(s):  
Dhivyaa Anandan ◽  
Shilin Zhao ◽  
Amy S. Whigham
Keyword(s):  
Length Of Stay ◽  
Pediatric Patients ◽  
Statistical Significance ◽  
Unit Length ◽  
Medication Administration ◽  
Dopamine Antagonists ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Family Presence ◽  
Postoperative Administration

Objectives: (1) To identify clinical factors and perioperative practices that correlate with longer length of stay (LOS) in the post-anesthesia care unit (PACU) after adenotonsillectomy (T&A) in pediatric populations. (2) To understand the relationship between family presence and PACU LOS for pediatric patients after T&A. Methods: Pediatric patients (ages 3-17) who underwent T&A between February 2016 and December 2016 were retrospectively reviewed. Factors assessed for impact on PACU LOS included BMI, preoperative medications, intraoperative medications/narcotics, postoperative medications/narcotics, method of postoperative medication administration, and family presence in the PACU. Kruskal–Wallis and Spearman tests were used to assess correlations. Statistical significance was set a priori at P < .05. Results: Our cohort included 500 patients. Patients were in the PACU for an average of 135.4 minutes (±65.8). Subset analyses of the type of medications administered intra-operatively and in the PACU show that the intraoperative administration of sedatives is associated with increased LOS ( P = .014). Postoperative administration of any medications ( P < .001), and specifically, postoperative administration of narcotics ( P < .001), analgesics ( P = .043), antihistamines ( P < .001), and dopamine antagonists ( P = .011), are associated with increased LOS. Administration of PACU medications by IV was also correlated with shorter LOS compared to oral administration of PACU medications ( P = .016). A comparison of patients who received PACU medications to those who did not demonstrated that intraoperative administration of acetaminophen was associated with a reduced need for PACU medication administration ( P = .012). Shorter waiting times for family arrival in the PACU was also associated with shorter LOS ( P < .001). Conclusion: Our results suggest that postoperative medication administration and time until family arrival in the PACU are associated with significant differences in LOS. We also find that intraoperative administration of acetaminophen is correlated with reduced need for postoperative medication administration. Standardizing postoperative practices to minimize PACU LOS could result in a more efficient recovery for pediatric patients undergoing T&A.

How does patient safety culture in the operating room and post-anesthesia care unit compare to the rest of the hospital?

2009 ◽  
Vol 198 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Haytham M.A. Kaafarani ◽  
Kamal M.F. Itani ◽  
Amy K. Rosen ◽  
Shibei Zhao ◽  
Christine W. Hartmann ◽  
...  
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Safety Culture ◽  
Patient Safety Culture ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit

Capnography Monitoring to Reduce Adverse Events in the Pediatric Post-Anesthesia Care Unit

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 189A-189A
Author(s):  
Melissa L. Langhan ◽  
Fangyong Li ◽  
Lance Lichtor
Keyword(s):  
Adverse Events ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit
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