“emergence delirium in children: an update”

“Emergence Delirium in

Children: An update”

A Journal Review by Dr Daveena M.

Supervised by Dr Tuan Norizan & Dr Rohani

EMERGENCE DELIRIUM

… dissociated state of consciousness in which the child is inconsolable, irritable, uncompromising or uncooperative, typically trashing, crying, moaning or incoherent…

Paranoid ideation

Don’t recognize , identify familiar or known object or person.

Generally self limiting though maybe harmful

Journal:

Review article “Emergence Delirium in Children: An update” – Souhayl Dahmani, Honorine Delevet and Julie Hillie

Journal review based from several studies

DiagnosingPrevention stratergies & therapy

Pain management Role of alpha-2-agonist

GenesisEmergence

Delirium

Postoperative Pain

Pharmacokinetics

Pharmacodynamics

Postoperative pain

Once recovered to normal state, patients did not report post operative pain

Can occur following non painful stimulus

Pharmacokinetics & Phamacodynamics

Variable rate of clearance of agents from CNS – variable rate of recovery of brain function

Evident with use of fast acting volatile agents

Fuctional conectivity network vs. the executive control network of the brain cannot coexist together in the presence of anaesthesia – confusion & agitation

Sevoflurane vs. Propofol

IncidenceVaries from 2 – 80%

Seen more in younger age group

Post ENT surgeries

Post anaesthesia for imaging

Seen more in sevoflurane & desflurane use vs. halothane & isoflurane

Benefits of propofol

More evident in men

Risk factors of emergent agitation

Sikich & Lerman’s PAEDSTo aid the diagnostic, a scale was developed

Paediatric Anaesthesia Emergence Delirium Scale

The sensibility and specificity analysis found an area under the curve of 76.6% with a threshold of 10 or moreProviding a sensibility of 64% & specificity of 86%

Adopted from South Afr J Anaesth Analg (SAJAA), 2011 – The agitated child in recovery.

Prevention is the AIM!!

Pharmacological Prevention Non-pharmacological

Prevention

Pharmacological

Propofol – 1mg/kg bolus or continuous infusion intra-op.

Fentanyl intraoperatively

Ketamine

Clonidine

Dexmedetomidine – bolus at the end 0.3mg/kg or continuously

Acetaminophen-Codeine +++

Gabapentine preoperatively

Midazolam++

Magnesium infusion intraoperatively

Non pharmacological

Focusing on decreasing preoperative anxiety

Informing parents about method of induction, encouraging them to distract child

TreatmentPAED Scale – aids diagnosis

To prevent intense agitation which in turn could cause self inflicted harm

Caregivers/parents calm child

Midazolam 0.1mg/kg

Propofol 1mg/kg

Fentanyl 1-2mcg/kg

Dexmedetomidine 0.3mg/kg

Thank you for your kind attention!