Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions
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REVIEW
Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions Ivan Urits . Jacquelin Peck . Stephen Giacomazzi . Riki Patel . John Wolf . Denzil Mathew . Ruben Schwartz . Hisham Kassem . Richard D. Urman . Alan D. Kaye . Omar Viswanath
Received: January 3, 2020 Ó Springer Healthcare Ltd., part of Springer Nature 2020
ABSTRACT Emergence delirium (ED) is defined as psychomotor agitation and delirium that typically occurs within 45 min from emergence of anesthesia. Preoperative patient conditions such as anxiety and confusion are risk factors for the development of postoperative ED. Common signs of ED are general non-purposeful resistive movements such as kicking, pulling, flailing as well as lack of eye contact and general lack of awareness of surroundings. The use of volatile Enhanced Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare. 12022770. I. Urits (&) Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA e-mail: [email protected]
anesthetics (VA) is contributory, while the use of total intravenous anesthetic techniques (TIVA) may help to reduce the incidence of emergence delirium. Furthermore, various pharmacologic strategies and alternatively nonpharmacologic strategies have been demonstrated to further diminish its occurrence. The objective of this manuscript is to provide a comprehensive review of anesthetic considerations for pediatric ED and to provide an update on techniques that have been found to be effective in reducing the overall risk of developing postoperative ED in pediatric patients.
Keywords: Anesthesia; Emergence agitation; Emergence delirium; Pharmacotherapy; Pediatrics; Post anesthetic excitement
J. Peck R. Schwartz H. Kassem Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
A. D. Kaye Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
S. Giacomazzi R. Patel J. Wolf D. Mathew O. Viswanath Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
O. Viswanath Valley Anesthesiology and Pain ConsultantsEnvision Physician Services, Phoenix, AZ, USA
R. D. Urman Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
O. Viswanath Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
Adv Ther
Key Summary Points Emergence delirium (ED) is defined as psychomotor agitation and delirium that typically occurs within 45 min from emergence of anesthesia Preoperative patient conditions such as anxiety and confusion are risk factors for the development of postoperative ED. Common signs of ED are general nonpurposeful resistive movements such as kicking, pulling, flailing as well as lack of eye contact and general lack of awareness of surroundings Various pharmacologic strategies and alternatively non-ph
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