Emergence Delirium in children

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Delirium after anesthesia, also known as emergence delirium (ED) is a clinical condition in which patients have alterations to their attention, awareness, and perceptions. In children, this often results in behavioral disturbances such as crying, sobbing, thrashing and disorientation. Emergence Agitation (EA) and Emergence Delirium (ED) are commonly used interchangeably; they describe two distinct conditions with emergence delirium being described in the anesthesia literature as a state of mental confusion, agitation, and dis-inhibition marked by some degree of hyper-excitability during recovery from general anesthesia. The commonly reported incidence of emergence delirium is about 10% to 30% of paediatric patients. Risk factors associated with emergence delirium are age, preexisting behaviours, types of surgery and the use of volatile anaesthesia. Transient agitation - delirium from sevoflurane anesthesia can lead to a variety of adverse events, such as airway spasm, shedding or displaced tracheal tube, dehiscence, or bleeding. Volatile anaesthetics may affect brain activity by interfering with the balance between neuronal synaptic inhibition and excitation in the central nervous system. Elevated postoperative pain has been suggested to underlie ED. But given that ED is seen in patients undergoing MRI, pain cannot be the sole cause. Treatment options include the use of premedication, analgesic adjuvants, single dose of propofol at the conclusion of the case. Midazolam premedication, intraoperative dexmedetomidine and fentanyl were associated with lower incidence of ED. The incidence of ED in patients receiving propofol is markedly lower than those receiving sevoflurane, despite the similar rapid emergence profile of both agents. Paediatric Assessment of Emergence Delirium (PAED) scale, developed specifically for children, is a valid and reliable scale. Watcha score is a simpler, reliable tool to measure emergence behaviour. There has been considerable progress in the neuroscience of anaesthesia and the application of new pharmacological agents, but the mystery behind the exact mechanism of ED is elusive. ED is a diagnosis of exclusion once other causes have been dismiss. There is no strong evidence of long-term effects and outcomes in children who developed emergence delirium after anesthesia. Prevention may be the best treatment but no one medication is entirely effective.