Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2017.11.002
Brazilian Journal of Anesthesiology
Scientific Article

Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery

Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial

Ana Carolina Tavares Paes Barreto; Ana Carolina Rangel da Rocha Paschoal; Carolina Barbosa Farias; Paulo Sérgio Gomes Nogueira Borges; Rebeca Gonelli Albanez da Cunha Andrade; Flávia Augusta de Orange

Downloads: 0
Views: 646

Abstract

Abstract Introduction: Anesthesia emergence delirium is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. Objective: To determine the prevalence and risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery. Methods: A prospective observational study was carried out with 100 children aged 2–10 years, who underwent surgery on an outpatient basis. The study variables were: anesthesia emergence delirium and the associated risk factors (preoperative anxiety, child impulsive behavior, use of pre-anesthetic medication, traumatic induction, type of anesthesia, and postoperative pain). Multivariate Poisson's logistic regression was used to analyze the possible explanatory variables, where the prevalence ratios were estimated with the respective 95% confidence intervals, considering a significance level of 5%. Results: Delirium and pain were observed in 27% and 20% of children, respectively. Only postoperative pain after Poisson's regression, was shown to be associated with anesthesia emergence delirium, with a prevalence ratio of 3.91 (p < 0.000). Conclusion: The present study showed 27% prevalence of anesthesia emergence delirium in the study population. The incidence of anesthesia emergence delirium was higher in children who had postoperative pain.

Keywords

Pain, Child, Delirium

Resumo

Resumo Introdução Delírio ao despertar anestésico é um fenômeno clínico autolimitado muito comum em crianças. Apesar de fisiopatologia ainda incerta, alguns fatores parecem estar envolvidos, como despertar rápido em um ambiente desconhecido, agitação durante a indução anestésica, ansiedade pré-operatória, perturbações ambientais, uso de medicação pré-anestésica, uso de anestésicos inalatórios e dor pós-operatória. Objetivo Determinar a prevalência e os fatores de risco associados ao delírio ao despertar anestésico em crianças submetidas à cirurgia ambulatorial. Métodos Estudo observacional prospectivo, envolveu 100 crianças entre dois e 10 anos, submetidos à cirurgia em caráter ambulatorial. As variáveis de estudo foram: delírio ao despertar anestésico e os fatores de risco associados (ansiedade pré-operatória, comportamento impulsivo da criança, uso de medicação pré-anestésica, indução traumática, tipo de anestesia e dor pós-operatória). Foi feita a regressão multivariada de Poisson para análise das possíveis variáveis explanatórias, na qual foram estimadas as razões de prevalência com os respectivos intervalos de confiança de 95%, considerou-se o nível de significância de 5%. Resultados Delírio e dor foram observados em 27% e 20% das crianças respectivamente. Apenas a dor no pós-operatório, após a regressão de Poisson, mostrou ter uma associação com o delírio ao despertar anestésico, cuja razão de prevalência foi 3,91 (p < 0,000). Conclusão O presente estudo evidenciou uma prevalência de delírio ao despertar anestésico de 27% na população estudada. A incidência de delírio ao despertar anestésico foi maior em crianças que apresentaram dor no pós-operatório.

Palavras-chave

Dor, Criança, Delírio

References

Rahimzadeh P, Faiz SH, Alebouyeh MR. Appropriate anesthesia regimen to control sevoflurane-induced emergence agitation in children; propofol-lidocaine and thiopental sodium-lidocaine: a randomized controlled trial. Iran Red Crescent Med J. 2014;16.

Moore AD, Anghelescu DL. Emergence delirium in pediatric anesthesia. Pediatric Drugs. 2017;19:11-20.

Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitement. A clinical survey. Anesthesiology. 1961;22:667-73.

Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg. 2003;96:1625-30.

Moore JK, Moore EW, Elliott RA. Propofol and halothane versus sevoflurane in paediatric daycase surgery: induction and recovery characteristics. Br J Anaesth. 2003;90:461-6.

Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth. 2000;10:419-24.

Aono J, Ueda W, Mamiya K. Greater incidence of delirium during recovery from sevoflurane in preschool boys. Anesthesiology. 1997;87:1298-300.

Przybylo HJ, Martini DR, Mazurek AJ. Assessing behaviour in children emerging from anaesthesia: can we apply psychiatric diagnostic techniques?. Paediatr Anaesth. 2003;13:609-16.

Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children. Anesth Analg. 2001;93:335-8.

Reduqye LR, Verghese ST. Paediatric emergence delirium. Contin Educ Anaesth Crit Care Pain. 2012;13:39-41.

Nasr VG, Hannallah RS. Emergence agitation in children: a review. Middle East J Anesthesiol. 2011;21:175-82.

Guaratini AA, Marcolino JAM, Teixeira AB. Estudo transversal de ansiedade préo-peratória em crianças: a utilização da escala de Yale modificada. Rev Bras Anestesiol. 2006;56:591-601.

Beskow A, Westrin P. Sevoflurane causes more postoperative agitation in children than does halothane. Acta Anaesthesiol Scand. 1999;43:536-41.

Hollister GR, Burn JM. Side effects of ketamine in pediatric anesthesia. Anesth Analg. 1974;53:264-7.

Shahmohammadi S, Baradari AF, Habibi MR. Factors contributing to postanesthetic emergence agitation in pediatric anaesthesia. J Pediatr Rev. 2013;1:69-79.

Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Curr Opin Anaesthesiol. 2014;27:309-15.

Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100:1138-45.

Silva LM, Braz LG, Módelo NS. Emergence agitation in pediatric anesthesia: current features. J Pediatr. 2008;84:107-13.

Broadman LM, Rice LJ, Hannallah RS. Comparison of physiological and a visual analogue pain scale in children. Can J Anaesth. 1988;35:S137-8.

Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitement. Anesthesiology. 1961;22:667-73.

Veyckemans F. Excitation phenomena during sevoflurane anaesthesia in children. Curr Opin Anesthesiol. 2001;14:339-43.

Bong CL, Ng ASB. Evaluation of emergence delirium in Asian children using the pediatric anesthesia emergence delirium scale. Pediatr Anesth. 2009;19:593-600.

Cho EJ, Yoon SZ, Cho JE. Comparison of the effects of 0.03 and 0.05 mg/kg midazolam with placebo on prevention of emergence agitation in children having strabismus surgery. Anesthesiology. 2014;120:1354-61.

Pieters BJ, Penn E, Nicklaus P. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. Pediatr Anesth. 2010;20:944-50.

Costi D, Cyna AM, Ahmed S. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014;9.

Davis PJ, Greeberg JA, Genldeman M. Recovery characteristics of sevoflurane and halothane in preschool-aged children undergoing bilateral myringotomy and pressure equalization tube insertion. Anesth Analg. 1999;88:34-8.

Isik B, Arslan M, Tunga AD. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Pediatr Anesth. 2006;16:748-53.

Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg. 2007;104:84-91.

Aouad MT, Nasr VG. Emergence agitation in children: an update. Curr Opin Anaesthesiol. 2005;18:614-9.

Picard V, Dumont L, Pellgrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand. 2000;44:307-31.

Sethi S, Ghai B, Ram J. Postoperative emergence delirium in pediatric patients undergoing cataract surgery: a comparison of desflurane and sevoflurane. Pediatr Anesth. 2013;23:1131-7.

Weldon BC, Bell M, Craddock T. The effect of caudal analgesia on emergence agitation in children after sevoflurane versus halothane anesthesia. Anesth Analg. 2004;98:321-6.

Martini DR. Commentary: the diagnosis of delirium in pediatric patients. J Am Acad Child Adolesc Psychiatry. 2005;44:395-8.

Kain ZN, Caldwell-Andrews AA, Maranets I. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg.. 2004;99:1648-54.

5dcc4d790e8825b968bf58f4 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections