Greta Patapavičiūtė, Laura Lukošienė, Ilona Razlevičė, Andrius Macas


Background: Emergence delirium (ED) is described as a transient state of cognitive disturbance and psychomotor agitation, which begins with emergence from anesthesia and continues through the early recovery period. The incidence of ED in the pediatric population remains unclear and ranges from 10 to 80%. The pathophysiology and underlying mechanisms of ED are also uncertain. This study aimed to determine the prevalence of ED, potential risk factors that may contribute to the development of ED and observe behaviour changes related to ED in the late postoperative period. Methods: A prospective observational study was carried out with children aged 1 to 12 years. The child’s behaviour before anesthesia was evaluated using the Pediatric Anesthesia Behavior (PAB) score. Medications used during the perioperative period were registered. The Watcha scale was used to evaluate if children developed ED and the Visual Analogue Scale (VAS) was used to register pain intensity during the first 15 minutes after the awakening. Parents of patients who experienced agitation were asked to assess their child’s behaviour two weeks after the anesthesia. Results: Among 136 observed patients 24 (17.6%) had ED. The duration of anesthesia among ED experienced patients was 45.42 (SD 18.35) min and it was significantly shorter than among children who didn’t develop ED – 60 (SD 29.03) min, p = 0.016. Eighteen (15.5%) patients in a mild pain group (VAS 0 to 3) experienced ED while in a moderate-25 severe pain group (VAS 4-10) there were 6 (37.5%) children who developed ED, p=0.033. However, age, the American Society of Anesthesiologists Classification (ASA) class, surgery type, behaviour before anesthesia induction and perioperative medications were not associated with ED. Conclusions: The prevalence of ED observed during our study, short duration of anesthesia and postoperative pain association with ED coincided with the results specified by other researchers. ED associated behavior changes were reported in the late postoperative period. Our other findings appeared to be not consistent with the results reported in other studies. Thus, the dilemma of ED still remains unresolved.

Raktiniai žodžiai: agitation, general anesthesia, children.

DOI: 10.35988/sm-hs.2021.115
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