Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.09.012
Brazilian Journal of Anesthesiology
Scientific Article

The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

Incidência de delírio ao despertar e fatores de risco após o uso de sevoflurano em pacientes pediátricos para cirurgia ambulatorial, Kingston, Jamaica

Rachel Gooden; Ingrid Tennant; Brian James; Richard Augier; Annette Crawford-Sykes; Kelvin Ehikhametalor; Georgiana Gordon-Strachan; Hyacinth Harding-Goldson

http://dx.doi.org/10.1016/j.bjane.2013.09.012 Braz J Anesthesiol, vol.64, n6, p.413-418, 2014
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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: One hundred and forty-five (145) children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min 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%.

Keywords

Emergence delirium, Agitation, Sevoflurane, Pediatric anesthesia

Resumo

Justificativa e objetivos: Delírio ao despertar é uma complicação preocupante após o uso de sevoflurano em anestesia geral. Este estudo procurou determinar a incidência de delírio ao despertar e os fatores de risco em pacientes de um hospital pediátrico especializado, em Kingston, Jamaica. Métodos: Estudo transversal e observacional, incluindo pacientes pediátricos com idades entre 3-10 anos, estado físico ASA I-II, submetidos à anestesia geral com sevoflurano para procedimentos eletivos em regime ambulatorial. Os dados coletados incluíram nível de ansiedade no pré-operatório medido com a Escala de Ansiedade Pré-operatória de Yale modificada, cirurgia realizada, duração da anestesia e analgésicos administrados. No período pós-operatório, os pacientes foram avaliados para verificar a incidência de delírio ao despertar, definido como Agitação com movimentos não-intencionais, inquietação ou debatimento; inconsolável e apático à presença de enfermeiros e/ou dos pais. A necessidade de tratamento farmacológico e as complicacões pós-operatórias relacionadas a episódios de delírio ao despertar também foram registradas. Resultados: 145 crianças foram incluídas, com incidência de delírio ao despertar em 28 (19,3%). Os episódios de delírio ao despertar apresentaram uma média de duração de 6,9 ±7,8 min; a intervenção farmacológica foi necessária em 19 pacientes (67,8%) e foi associada ao tempo de recuperação prolongado (49,4 ±11,9 versus 29,7 ±10,8 min para crianças não-agitadas; p<0,001). Os fatores positivamente associados ao delírio ao despertar incluíram idade mais jovem (p = 0,01, OR 3,3, IC95 1,2-8,6) e ansiedade moderada e grave pré-indução (p <0,001, OR 5.6, IC95 2,3-13,0). As complicacões do delírio ao despertar incluíram a remoção da linha intravenosa (n = 1) e sangramento do sítio cirúrgico (n = 3). Conclusão: As crianças mais jovens que apresentam ansiedade séria no período pré-operatório possuem maior risco de desenvolver delírio pós-anestesia geral com sevoflurano. A incidência global de delírio foi de 19%.

Palavras-chave

Delírio de emergência, Agitação, Sevoflurano, Anestesia pediátrica

References

Eger EI. New inhaled anesthetics. Anesthesiology. ;80:922-906.

Wallin RF, Regan BM, Napoli MD. Sevoflurane: a new inhalational anesthetic agent. Anesth Analg. ;54:758-766.

Smith I, Nathanson M, White PF. Sevoflurane—a long-awaited volatile anaesthetic. Br J Anaesth. ;76:435-445.

Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg. ;104:91-84.

Veyckemans F. Excitation and delirium during sevoflurane anesthesia in pediatric patients. Minerva Anestesiol. ;68:405-402.

Malarbi S, Stargatt R, Howard K. Characterizing the behavior of children emerging with delirium from general anesthesia. Paediatr Anaesth. ;21:950-942.

Bajwa SA, Costi D, Cyna AM. A comparison of emergence delirium scales following general anesthesia in children. Paediatr Anaesth. ;20:704-711.

Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg. ;96:1630-1625.

Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitement. A clinical survey. Anesthesiology. ;22:667-673.

Hudek K. Emergence delirium: a nursing perspective. AORN J. ;89:516-509.

Kain ZN, Mayes LC, Cicchetti DV. The Yale Preoperative Anxiety Scale: how does it compare with a "gold standard"?. Anesth Analg. ;85:788-783.

Aono J, Ueda W, Mamiya K. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. ;87:1298-1300.

Saringcarinkul A, Manchupong S, Punjasawadwong Y. Incidence and risk factors of emergence agitation in pediatric patients after general anesthesia. J Med Assoc Thai. ;91:1226-1231.

Kain ZN, Caldwell-Andrews AA, Maranets I. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. ;99:1648-1654.

Weldon BC, Bell M, Craddock T. The effect of caudal analgesia on emergence agitation in children after sevoflurane versus halothane anesthesia. Anesth Analg. ;98:321-326.

Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth. ;18:55-59.

Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth. ;10:419-424.

Manworren RC, Paulos CL, Pop R. Treating children for acute agitation in the PACU: differentiating pain and emergence delirium. J Perianesth Nurs. ;19:183-193.

Davis PJ, Greenberg JA, Gendelman M. Recovery characteristics of sevoflurane and halothane in preschool-aged children undergoing bilateral myringotomy and pressure equalization tube insertion. Anesth Analg. ;88:38-34.

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