Teary Tots, Yelling Youths, and Kicking Kids: A Synopsis of Pediatric Emergence Delirium/Agitation, Treatment and Prevention

Abstract

As with all areas of medical treatment, pediatric surgery rates are increasing annually. Coupled with this is the need for safe, effective anesthetic care. In 2006, about 2.3 million American youths under the age of 15 incurred anesthetics for ambulatory surgery. In addition, approximately 450,000 American youths under the age of 18 underwent inpatient anesthetic/surgical care. An estimated 25% of these patients are 3 years of age or younger. The majority of pediatric procedures are performed under general anesthesia (GA), with/without local anesthetic, and initiated by way of inhalational induction with sevoflurane and oxygen (02), with or without nitrous oxide (N20). GA is predominantly maintained with the same agents. Upon emergence, and continuing for an average of 30 minutes postoperatively, 2-80% of these patients (approximately 55,000 to 2.2 million) will experience inconsolable crying, thrashing, and screaming, which creates a potential for harm to themselves or others, including healthcare providers. This behavior can delay hospital discharge, possibly resulting in unanticipated inpatient admission for follow-up care/treatment. Furthermore, new onset of maladaptive behaviors in the postoperative period lasting a month or longer have been documented. Without proper prevention, diagnosis, and treatment, these patients fall subject to pediatric emergence delirium (ED), commonly termed emergence agitation (EA).