Severity Of Emergence Delirium Research Articles

The effect on perioperative anxiety and emergence delirium of the child or parent's preference for parental accompaniment during anesthesia induction in children undergoing adenotonsillectomy surgery.

Pediatric emergence delirium (ED) occurs in the early postoperative period and is defined as a complex psychiatric disorder. Non-pharmacological methods of treatment, such as perioperative parental presence, have been the focus of many studies, but the impact on preventing ED of which parent accompanies the child during anesthesia induction has not been identified as yet. Therefore, the aim of this study was to determine whether the selection made by children undergoing adenotonsillectomy of which parent will accompany them during anesthesia induction has the effect of reducing postoperative delirium scores and incidence compared to selections made by the parents. The study included 80 children of both genders, aged 5-12 years, who underwent day-case surgery in the otorhinolaryngology clinic. The patients were separated randomly into two groups of 40. In Group 1, the children were asked to choose which of their parents would accompany them during general anesthesia induction, and in Group 2, the parents were asked to decide who would be the accompanying parent. Evaluation of postoperative delirium was made using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The anxiety level of the children was evaluated with the modified Yale Preoperative Anxiety Scale (mYPAS) both in the preoperative waiting area and during the anesthesia induction. The State-Trait Anxiety Inventory (STAI) was used to evaluate the anxiety level of the parents. The mean PAED scores were similar in both groups (mean difference [95% CI]: -0.1 [-2.8 to 0.7]). The incidence of emergence delirium was also similar in both groups (risk ratio 0.9 [0.4 to 1.8]). The mean mYPAS scores during the induction of anesthesia of Group 1 was lower than that of Group 2 (mean difference [95% CI]: -8.4 [-15.2 to -1.6]). The mean mYPAS scores evaluated in the preoperative waiting area were found to be similar in the two groups (mean difference [95% CI]: -1.9 [-7.5 to 3.5]). The mean STAI anxiety scores of the parents were similar in both groups, with higher scores obtained by mothers compared to fathers, at all measurement times. The incidence or severity of ED did not decrease significantly even though lower anxiety scores were obtained during anesthesia induction in children who were allowed to make the decision of accompanying parent. Based on these findings, it can be concluded that postoperative delirium is a more complicated process that can be affected by many other variables rather than just the parent-child general interaction.

Prophylaxis for paediatric emergence delirium in desflurane-based anaesthesia: a network meta-analysis.

The prevalence of postoperative emergence delirium in paediatric patients (pedED) following desflurane anaesthesia is considerably high at 50-80%. Although several pharmacological prophylactic strategies have been introduced to reduce the risk of pedED, conclusive evidence about the superiority of these individual regimens is lacking. The aim of the current study was to assess the potential prophylactic effect and safety of individual pharmacotherapies in the prevention of pedED following desflurane anaesthesia. This frequentist model network meta-analysis (NMA) of randomized controlled trials (RCTs) included peer-reviewed RCTs of either placebo-controlled or active-controlled design in paediatric patients under desflurane anaesthesia. Seven studies comprising 573 participants were included. Overall, the ketamine + propofol administration [odds ratio (OR) = 0.05, 95% confidence intervals (95%CIs) 0.01-0.33], dexmedetomidine alone (OR = 0.13, 95%CIs 0.05-0.31), and propofol administration (OR = 0.30, 95%CIs 0.10-0.91) were associated with a significantly lower incidence of pedED than the placebo/control groups. In addition, only gabapentin and dexmedetomidine were associated with a significantly higher improvement in the severity of emergence delirium than the placebo/control groups. Finally, the ketamine + propofol administration was associated with the lowest incidence of pedED, whereas gabapentin was associated with the lowest severity of pedED among all of the pharmacologic interventions studied. The current NMA showed that ketamine + propofol administration was associated with the lowest incidence of pedED among all of the pharmacologic interventions studied. Future large-scale trials to more fully elucidate the comparative benefits of different combination regimens are warranted. PROSPERO CRD42021285200.

Effect of S-ketamine administered at the end of anesthesia on emergence delirium in preschool children undergoing tonsillectomy and/or adenoidectomy.

Background: S-ketamine (the S-isomer of ketamine) is twice as potent as the racemic mixture of this agent and carries fewer side effects when administered to humans. Information regarding the use of S-ketamine for the prevention of emergence delirium (ED) is limited. Thus, we evaluated the effect of S-ketamine administered at the end of anesthesia on ED in preschool children undergoing tonsillectomy and/or adenoidectomy. Methods: We investigated 108 children aged 3-7years, who were scheduled for elective tonsillectomy and/or adenoidectomy under general anesthesia. They were randomly assigned to receive either S-ketamine 0.2mg/kg or an equal volume of normal saline at the end of anesthesia. The primary outcome was the highest score on the pediatric anesthesia ED (PAED) scale during the first 30min post-surgery. The secondary outcomes included the incidence of ED (defined as a score of ≥ 3 on Aono scale), pain score, time to extubation, and incidences of adverse events. Multivariate analyses were also performed using logistic regression to evaluate the independent factors predictive of ED. Results: The median (interquartile range) PAED score of the S-ketamine group (0 [0, 3]) was significantly lower than that in the control group (1 [0, 7]) (estimate median difference = 0, 95% confidence interval -2 to 0, p = 0.040). Significantly fewer patients in the S-ketamine group had an Aono scale score ≥ 3 (4 [7%] vs. 12 [22%], p = 0.030). Patients in the S-ketamine group also had a lower median pain score than did control subjects (4 [4, 6] vs. 6 [5, 8], p = 0.002). The time to extubation and incidences of adverse events were comparable between the two groups. However, multivariate analyses indicated that except S-ketamine use, pain scores, age and duration of anesthesia were independent factors predictive of ED. Conclusion: S-ketamine (0.2mg/kg) administered at the end of anesthesia effectively reduced the incidence and severity of ED in preschool children undergoing tonsillectomy and/or adenoidectomy without prolonging the time to extubation or increasing adverse events. However, S-ketamine use was not an independent factor predictive of ED.

Comparison of dexmedetomidine and clonidine for the prevention of emergence delirium in children undergoing lower abdominal surgery under sevoflurane anesthesia

Abstract Objective: In this study, we compared the efficacy of dexmedetomidine, clonidine, and placebo in the prevention of emergence delirium (ED) in children undergoing lower abdominal surgeries under sevoflurane anesthesia. Materials and Methods: We conducted a prospective randomized double-blinded study on 75 patients aged 4–10 years belonging to the American Society of Anesthesiologists I or II, undergoing lower abdominal surgeries of 1–2 h duration under sevoflurane anesthesia. The children were randomly distributed into three groups: dexmedetomidine (Group D), clonidine (Group C), and saline group (Group S). The study drug was administered 10 min after induction of anesthesia. Intraoperative hemodynamic parameters were recorded. The Pediatric Anesthesia Emergence Delirium (PAED) score was used to assess the incidence and severity of ED at 0, 5, 10, 15, 20, 30, 45, and 60 min of arrival to the postanesthesia care unit. A score of ≥10 was considered to have ED. The Ramsay Sedation Score and the Face, Legs, Activity, Cry, Consolability (FLACC) score were used to assess the degree of sedation and the severity of pain, respectively. Results: Dexmedetomidine showed the lowest incidence of ED while the highest incidence was seen in the saline group. The PAED score was lowest in the dexmedetomidine group, followed by clonidine, and highest in the control group at all time intervals. The Ramsay Sedation Score and FLACC score were also lower in the dexmedetomidine group as compared to the clonidine and saline groups. Conclusion: Dexmedetomidine was found to be more efficacious in preventing ED as compared to clonidine in children.

A Perioperative Intervention to Prevent and Treat Emergence Delirium at a Veterans Affairs Medical Center

Emergence delirium (ED) is a temporary condition associated with a patient awakening from an anesthetic and/or adjunct agent (e.g., sedatives and analgesics). During the condition, patients risk harming themselves or staff by engaging in dangerous behavior, which may include thrashing, kicking, punching, and attempting to exit the bed/table. A multidisciplinary team at Veterans Affairs Pittsburgh Healthcare System (VAPHS) developed and implemented a multicomponent intervention to reduce the severity and occurrence of ED. The intervention consists of a training component and 21 clinical components. The 21 clinical components are implemented on a patient-by-patient basis and include routine screening for risk factors, enhanced communication among staff, adjusting the environment, following a specific medication strategy, and application of manual restraint (hands-on). The authors provide 15 online Supplemental Materials (S1–S15) to promote replication of the intervention. To our knowledge, this is the first manuscript that describes this type of multicomponent intervention in sufficient detail to allow others to replicate it. Following implementation of the intervention at VAPHS, perioperative staff reported that they observed a substantial reduction in the occurrence and severity of ED, ED-related patient and staff injuries, and ED-related loss of intravenous access and airway patency. Despite staff’s reported success of the intervention, rigorous research is needed to evaluate the efficacy of the intervention.

The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial.

BackgroundEmergence delirium can occur after general anesthesia in children. An intravenous infusion of alfentanil may reduce the incidence or severity of emergence delirium after sevoflurane anesthesia.ObjectiveThe study aimed to investigate the effects of alfentanil intravenous infusion on emergence delirium and other perioperative complications.MethodThis was a single-center, randomized, placebo-controlled, double-blind clinical trial. A total of 172 children undergoing ambulatory dental treatment were randomized into three groups. Alfentanil group Alf2 received 0.2 μg/kg/min of alfentanil for continuous infusion, alfentanil group Alf4 received 0.4 μg/kg/min alfentanil, and the saline group (group Sal) received a continuous infusion of normal saline, with the same volume as the two other groups, as a placebo. The incidence of emergence delirium (assessed by the Paediatric Anaesthesia Emergence Delirium [PAED] scale), hemodynamic parameters, and recovery characteristics were recorded during the recovery period. The Aono scale was also used to assess for emergence delirium. A WeChat applet was designed to facilitate a caregiver teleconsultation and to provide feedback on postoperative nausea and vomiting and any other complications after discharge.ResultsThe incidence of emergence delirium in group Alf2 (22.9%) and group Alf4 (21.1%) was significantly lower than that observed in the Sal group (48.3%). The PAED scores in group Alf2 (6.4 ± 3.5) and group Alf4 (5.8 ± 3.8) were significantly lower than those for group Sal (9.6 ± 5.1) (p < 0.01). Ten children in the Alf4 group needed manual ventilatory assistance to maintain end-tidal carbon dioxide (ETCO2) < 55 mm; children in group Alf2 did not. There was no significant difference between the discharge time of groups Alf2 and Sal (31.2 ± 4.64 vs 30.5 ± 2.82 min; 0.659 [95% confidence interval {CI} −1.052 to 2.369], p = 0.643); the time to discharge of group Alf4 (35.16 ± 3.97 min) was significantly longer than that of groups Alf2 and Sal (p < 0.01). The incidence of nausea and vomiting was similar in the three groups. No other clinically relevant adverse events were observed.ConclusionsIntravenous infusion of 0.2 μg/kg/min and 0.4 μg/kg/min alfentanil decreased the incidence of emergence delirium in the post-anesthesia care unit. The 0.2 μg/kg/min dose of alfentanil resulted in less respiratory depression and discharge delay than the 0.4 μg/kg/min alfentanil dose.Trial registrationChinese Clinical Trial Registry (ChiCTR2100043320)Supplementary InformationThe online version contains supplementary material available at 10.1007/s40272-022-00510-5.

Emergence Delirium in Paediatric Anaesthesia

Emergence delirium(ED) in children is a well-documented clinical phenomenon with incidence rangingfrom 25 to 80%. It is characterized by confusion, mental irritability, disorientation, inconsolable crying,and thrashing. No single factor can identified as the cause of postoperative agitation, which shouldtherefore be considered a syndrome made up of biological, pharmacological, psychological and socialcomponents. Possible causes and risk factors include child’s personality, inhalation anaesthetics,surgery of head and neck, rapid awakening and pain. Many scales have been proposed to evaluate theincidence and severity of ED and a variety of scales are used in clinical practice and for researchpurposes in children. Preventive measures include the co-administration of propofol, midazolam, orfentanyl, but the risks associated with their use must be weighed against the self-limiting nature of ED.Once ED is established, the most common interventions are pharmacological. Treatment options areclam environment in recovery and with agents having sedative and analgesic effect,such as propofol,fentanyl, ketamine andalpha-2 receptor agonists (clonidine and dexmedetomidine). ED may increasethe incidence of new-onset postoperative maladaptive behavior changes such as general anxiety,night-time crying, bed wetting, general anxiety and loss of appetite for up to 14 days after surgery. Astandard diagnostic, preventable and treatable guideline should be required for adverse outcomes in thepaediatric populations. JBSA 2021; 34 (2) : 16-23

Comparison of oral Midazolam versus Combination of Low Dose Oral Midzolam–Ketamine for Premedication in Paediatric Surgical Patients

Background and need for study: One of the challenge faced by paediatric anaesthesiologist is the allaying of fear of a child in the preoperative period. Among the commonly used premedicant in children, midazolam is the front runner. A combination low dose of ketamine and midazolam have been tried to overcome the deficiencies of ketamine and midazolam alone. Aims: This research was planned to compare the effectiveness of combination of low dose midzolam–ketamine with oral midazolam alone as a premedicant in paediatric patients in terms of degree of sedation, separation from parents, mask acceptance, and postoperative recovery Design: Prospective, randomised, double blind controlled study. Methods: Sixty children of ASA physical status I or II, aged between 1 and 12 years, who were scheduled to undergo elective minor surgery were randomised into two groups M and MK of thirty children each. Children in group M were administered with oral midazolam 0.5 mg.kg-1 mixed with 2 ml of honey and group MK were administered with combination of low dose oral midzolam (0.25 mg.kg-1) &amp; oral ketamine (3 mg.kg-1) for premedication mixed with 2 ml of honey. Patient was assessed for parental separation anxiety, mask acceptance, level of sedation and emergence delirium. Statistical Analysis: Difference with respect to anxiety at separation from parents and tolerance to mask between the two groups was analysed using chi-square test . Difference with respect to incidence and severity of emergence delirium between the two groups was analysed using an independent sample t test . The P &lt;0.05 was considered significant. Results: Parental separation was acceptable in 23 patients (76.7%) in group M and 28 patients in (93.3%) in group MK (Table 2, 3). Mask acceptance was satisfactory in 13 (43.3%) in group M and 19(63.3%) in group MK. Post-operative delirium was noted in one patient in each group. Conclusion: The low dose mixture of ketamine and midazolam provides better parental separation and mask acceptance with better cooperation during induction of anaesthesia.

Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial.

Emergence delirium (ED) is common in children after sevoflurane anesthesia and should be prevented for patient safety. A prospective, double-blind, randomized, controlled study was performed to compare the efficacy of minimal dosage of midazolam versus dexmedetomidine to prevent ED in children undergoing tonsillectomy. Seventy children aged 24months to 12years were allocated to receive midazolam (0.03mg/kg) or dexmedetomidine (0.3µg/kg) 5min before the end of surgery. The incidence and severity of ED were assessed using a four-point scale and the pediatric anesthesia emergence delirium scale, respectively. The emergence time and postoperative pain scores were also evaluated. The incidence of ED was 31.3% in the midazolam group and 26.5% in the dexmedetomidine group (P = 0.668). The severity of ED was similar in both groups (9.6 ± 5.8 in the midazolam group, vs. 8.1 ± 5.9 in the dexmedetomidine group, P = 0.299). The emergence time was comparable in the two groups [11.0 (8.3-13.8) min in midazolam group vs. 12.0 (10.0-13.5) min in dexmedetomidine group (P = 0.218)]. Postoperative pain score was higher in the midazolam group [0 (0-1)] than in the dexmedetomidine group [0 (0-0)] (P = 0.011). Dexmedetomidine and midazolam at single minimum dosages had equal effectiveness to prevent ED in children without delaying emergence time, when administered at the end of surgery. With regards to postoperative analgesic efficacy, although dexmedetomidine showed statistically significant higher analgesic effect than midazolam, further clinical investigations are needed to validate our findings.

The effect of an immersive virtual reality tour of the operating theater on emergence delirium in children undergoing general anesthesia: A randomized controlled trial.

An immersive virtual reality tour of the operating theater could reduce preoperative anxiety. This study was designed to determine whether a preoperative immersive virtual reality tour demonstrates a reduction in emergence delirium through reducing the preoperative anxiety in children undergoing general anesthesia. Eighty-six children were randomly allocated into either the control or virtual reality group. The control group received conventional education regarding the perioperative process. The virtual reality group watched a 4-minute virtual reality video showing the operating theater and explaining the perioperative process. Incidence and severity of emergence delirium were the main outcomes. Secondary outcomes included preoperative anxiety using modified Yale Preoperative Anxiety Scale and postoperative behavioral disturbance. Eighty children completed the final analysis (control group=39, virtual reality group=41). The incidence (risk ratio [95% CI]: 1.1 [0.5-2.8], P=0.773) and severity of emergence delirium (mean difference [95% CI]: -0.2 [-2.7 to 2.2], P=0.791) were similar in the two groups. After the intervention, children in the virtual reality group had a significantly lower modified Yale Preoperative Anxiety score than those in the control group (mean difference [95% CI]: 9.2 [0.3-18.2], P=0.022). No difference was observed regarding postoperative behavioral disturbance between the two groups at postoperative 1day (mean difference [95% CI]: -0.1 [-0.3 to 0.1], P=0.671) and 14day (mean difference [95% CI]: -0.0 [-0.1 to 0.0], P=0.329). Preoperative immersive virtual reality tour of the operating theater did not reduce the incidence and severity of emergence delirium, although it was effective in alleviating preoperative anxiety in children.

Dexmedetomidine for the reduction of emergence delirium in children undergoing tonsillectomy with propofol anesthesia: A double-blind, randomized study.

Postanesthesia emergence delirium is a motor agitation state complicating pediatric anesthesia. We investigated the efficacy of dexmedetomidine in reducing emergence delirium in children undergoing tonsillectomy with and without adenoidectomy using total intravenous anesthesia with propofol. This was a prospective, single-center, double-blind, randomized study. The primary outcome was the presence or absence of emergence delirium with and without dexmedetomidine. Secondary outcomes were emergence delirium severity, time to extubation, cardiovascular stability, and need for additional postoperative analgesia. Eligible were children 3-14 years of age, ASA I or II, scheduled for tonsillectomy with or without adenoidectomy. Patients were randomized to receive dexmedetomidine 1 mcg kg-1 or a volume matched normal saline solution. Presence of emergence delirium and agitation severity was assessed with the Watcha scale 10, 20, and 30 minutes after arrival in the postanesthesia care unit. Sixty children participated to the study, 31 (51.7%) of them were treated with dexmedetomidine. Their mean age was 6.2 years (SD 5.5). Duration of anesthesia and surgery and blood pressure measurements did not differ between groups. Extubation time was not different between groups. The dexmedetomidine group had a significantly lower frequency of emergence delirium compared with no dexmedetomidine after 20 and 30 minutes in postanesthesia care unit: 16.1% and 12.9% at 20 and 30 minutes in the dexmedetomidine group vs 48.3% and 41.4% in in the no dexmedetomidine group. Dexmedetomidine 1 mcg kg-1 reduces the incidence and severity of emergence delirium after tonsillectomy with propofol anesthesia without prolonging the extubation time.

Military Service Members and Emergence Delirium Screening: An Evidence-Based Practice Project

Emergence delirium (ED) is a postoperative phenomenon characterized by agitation, confusion, and violent physical or verbal behavior that can occur after general anesthesia. Preoperative identification of patients at risk for ED may allow providers to take steps to minimize the incidence or severity of ED. Because no formal tool currently exists, the purpose of this project was to develop and evaluate a screening tool based on available evidence of ED risk factors. This quality improvement project used a preimplementation and postimplementation design. One hundred consecutive adult patient charts were reviewed 2months before implementation of the project questionnaire. These data were used to confirm preimplementation screening rates. Postimplementation, prospective data were gathered to test this newly developed assessment tool for usefulness in the clinical setting. The use of this focused screening tool significantly increased preoperative identification of patients at risk for ED compared with the preimplementation preoperative screening routine. Identification rates for at-risk patients rose from 5% to 21%-22.5% using this tool. This project demonstrated that the use of a focused tool to identify risk factors for ED could significantly increase actual identification rates for at-risk patients in the clinical setting.

Effects of dexmedetomidine on emergence delirium in pediatric cardiac surgery.

The present study aimed to investigate the effects of dexmedetomidine on emergence delirium (ED) in pediatric patients undergoing cardiac surgery. Fifty children of both sexes aged 1-6 years weighing 10-25 kilograms, with American Society of Anesthesiologists (ASA) physical status grade II, undergoing sevoflurane-based general anesthesia for elective cardiac surgery, were randomly assigned to two groups. The dexmedetomidine group (group D, N.=25) received 0.5 µg/kg of dexmedetomidine over 10 minutes, followed by an infusion at 0.5 µg/kg/h until the end of the surgery, whereas the saline group (group S, N.=25) received volume-matched normal saline immediately after the induction of anesthesia. Blood samples were taken preoperatively (T0), at different time points during surgery (T1-T5), and during the postoperative period (T6-T7) to determine serum melatonin, cortisol, norepinephrine, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and blood glucose levels. In the cardiac intensive care unit (CICU), the incidence of ED was assessed with a 5-point scale, and the severity of ED was assessed with the Pediatric Anesthesia Emergence Delirium scale (PAED) every two hours for the first 24 hours after surgery. ED was considered when the 5-point scale score was ≥4 for more than 5 minutes, or the PAED score was ≥10. Based on comparable demographic profiles, the scores of the 5-point scale and PAED Scale were significantly lower in group D compared with group S (P=0.028 and P=0.009, respectively). In addition, the fluctuation in the level of melatonin was significantly less in group D. Serum cortisol, norepinephrine, IL-6, TNF-α and glucose levels were increased in the two groups, but these increases were significantly less in group D than in group S. The consumption of sevoflurane during anesthesia was significantly less in group D (P=0.0002). The postoperative consumption of fentanyl was less in group D (P=0.04), whereas the pain scores were not significantly different (P=0.502). Extubation time was significantly delayed in group D compared with group S (P=0.032), whereas CICU and hospital stay were comparable between the two groups. Continuous intraoperative infusions of dexmedetomidine in pediatric patients undergoing cardiac surgery reduce sevoflurane requirements and decrease the incidence of ED, which is associated with decreasing plasma melatonin levels and surgical stress.

Emergence delirium is related to the invasiveness of strabismus surgery in preschool-age children.

To investigate the correlation between preoperative anxiety and emergence delirium (ED), and to identify other factors that contribute to ED (such as invasiveness of surgery), in preschool-age paediatric patients undergoing strabismus surgery. This prospective observational study enrolled Korean children (aged 2-5 years), scheduled for strabismus surgery. After completing the modified Yale Preoperative Anxiety Scale, general anaesthesia was induced. Postoperatively, Pediatric Anesthesia Emergence Delirium (PAED) scores (used as an index of the degree of ED) and a four-point delirium scale (ED incidence), were collected and measured every 5 min. Patients were categorized according to the degree of surgical invasiveness: group U-S, single-muscle correction in a unilateral eye; group U-M, multiple-muscle correction in a unilateral eye; group B-S, single-muscle correction in bilateral eyes; group B-M, multiple-muscle correction in bilateral eyes. A total of 90 paediatric patients participated in the study. Maximum PAED scores did not correlate with the presence of preoperative anxiety. The maximum PAED score of group B-M was significantly higher than scores observed in other groups. Preoperative anxiety was not related to ED in preschool-age paediatric patients undergoing strabismus surgery. The incidence and severity of ED was higher in patients who underwent more complicated strabismus surgery, compared with those undergoing simpler procedures.

Paediatric emergence delirium

A child with emergence delirium (ED) is in a ‘dissociated state of consciousness in which the child is irritable, uncompromising, uncooperative, incoherent, and inconsolably crying, moaning, kicking, or thrashing’. ED can disrupt the surgical repair, be distressing for parents and staff and may cause parental dissatisfaction with their child’s care. Many scales have been proposed to evaluate the incidence and severity of ED, and a variety of scales are used in clinical practice and for research purposes. Agitation due to pain is a significant confounding factor for the evaluation of the presence or measurement of the degree of ED. The Cravero scale (Table 1) has five steps from obtunded and unresponsive to wild thrashing behaviour requiring restraint. A score of 4 (from crying and difficult to console to wild thrashing) for a 5 or more min duration despite active calming efforts is regarded as indicative of ED. The Paediatric Anaesthesia Emergence Delirium (PAED) scale (Table 2) is validated but is difficult to use in routine clinical practice. The Watcha scale (Table 3) is a simpler tool to use in clinical practice and may have a higher overall sensitivity and specificity than the PAED and Cravero scales. It is more practical to use a simple scale to detect delirium and then use the PAED scale to measure its degree.

Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia

Emergence delirium (ED) is a frequent postoperative complication in young children undergoing ENT procedures and it may be exacerbated by sevoflurane anesthesia whereas propofol maintenance has been suggested to decrease the incidence of ED. The aim of this randomized, prospective, double-blind study was to evaluate the effect of sevoflurane vs propofol anesthesia on the quality of recovery after adenotonsillectomy. Forty-two patients were randomized to maintenance with either propofol or sevoflurane for adenotonsillectomy. At the conclusion of surgery, patients were extubated awake. ED and pain were assessed using the Pediatric Anesthesia Emergence Delirium (PAED) and the Children's Hospital of Eastern Ontario Scale (CHEOPS), respectively. Higher PAED scores (0-20) indicate greater severity of ED. Nursing and parental satisfaction, hospital length of stay, postoperative nausea and vomiting (PONV), anesthetic complications, and subsequent emergency room admissions were also assessed. Median PAED score was 14 in the propofol group and 17 in the sevoflurane group (NS). Propofol was associated with less pain medication required during recovery and a lower incidence of PONV (5.3% vs 36.8%, P < 0.05). Nursing and parental satisfaction as well as time spent in recovery room was similar for the two groups. Propofol anesthesia does not influence agitation after adenotonsillectomy, as measured by the PAED score. A PAED score of ≥ 10 was not useful in identifying patients with ED. However, propofol maintenance is associated with less need for pain medication in the recovery room and a lower incidence of PONV compared to sevoflurane anesthesia.