Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.008
Brazilian Journal of Anesthesiology
Clinical Research

Pediatric emergence delirium is linked to increased early postoperative negative behavior within two weeks after adenoidectomy: an observational study

Anne Houben, Shahab Ghamari, Andreas Fischer, Claudia Neumann, Torsten Baehner, Richard K. Ellerkmann

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Abstract

Background
The aim of this prospective multicenter observational study was to measure the incidence of postoperative pediatric emergence delirium and to investigate the occurrence of early postoperative negative behavior within two weeks after outpatient adenoidectomy in preschool children.

Methods
The study comprised 222 patients (1–7 years of age). All children received a multimodal anesthesia based on total intravenous anesthesia with propofol and remifentanil in combination with piritramid (0.1 mg.kg-1), ibuprofen (10 mg.kg-1), dexamethason (0.15 mg.kg-1) and ketanest S (0.1 mg.kg-1). We evaluated emergence delirium using the Pediatric Anesthesia Emergence Delirium Scale (PAED) at different predefined time points during the recovery period. Emergence delirium was defined as a PAED score ≥ 9 for the first three criteria. Additionally, we defined early postoperative negative behavior to be present when at least 5 of 27 criteria of the post hospitalization behavior questionnaire were positive.

Results
The incidence of emergence delirium following our anesthetic regime was 23%. The incidence of early postoperative negative behavior was significantly higher among patients with emergence delirium (24% vs. 11%,p =  0.04). The two categories, “sleep disturbance” and “separation anxiety”, tested within the questionnaire for early postoperative negative behavior were identified as the most common postoperative negative behavioral changes.

Conclusion
Emergence delirium not only plays a role immediately after surgery but is also linked to early postoperative negative behavior within two weeks after outpatient adenoidectomy. Parents should be informed that early postoperative negative behavior may occur in 1 out of 4 patients if emergence delirium was present postoperatively.

Keywords

Adenoidectomy,  Behavior,  Emergence delirium,  Anesthesia,  Child,  Preschool
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Braz J Anesthesiol

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