Download - “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!