Rachel Gooden1, Ingrid Tennant2, Brian James3, Richard Augier4, Annette Crawford-Sykes4, Kelvin Ehikhametalor4, Georgiana Gordon-Strachan5, Hyacinth Harding-Goldson4. 1. Bustamante Hospital for Children, South East Regional Health Authority, Kingston, Jamaica; Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica. 2. Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica. Electronic address: ingrid@landscreek.net. 3. Bustamante Hospital for Children, South East Regional Health Authority, Kingston, Jamaica. 4. Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica. 5. Unidade de Recursos para Pesquisa em Saúde, Dean's Office, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica.
Abstract
BACKGROUND AND OBJECTIVES: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. METHODS: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. RESULTS: 145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7±10.8min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p=0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p<0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n=1), and surgical site bleeding (n=3). CONCLUSION: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.
BACKGROUND AND OBJECTIVES:Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. METHODS: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. RESULTS: 145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7±10.8min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p=0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p<0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n=1), and surgical site bleeding (n=3). CONCLUSION:Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.