Paediatric Emergence Delirium: A Comprehensive Review and Interpretation of the Literature

Abstract

This article considers the evolution of emergence delirium (ED) and emergence agitation since it was first identified in the 1960s to assess present and future trends in identification, treatment, and prognostic value. There is a need for well-designed large prospective studies to assess ED risk factors and eliminate confounders as well as a need for standardized screening, evaluation tools, and data sharing in order to easily compare outcomes for researchers of pediatric ED (characterized by crying, sobbing, thrashing about, and disorientation following anesthesia). Emergence delirium should therefore be considered a “vital sign” to be consistently documented in the pediatric postanesthesia recovery period. The Paediatric Anaesthesia Emergence Delirium (PAED) scale, which assigns scores based on exhibited behavior, is used to identify ED currently. Because of problems in assessing normal behavior in children (especially those with special needs) in a stressful clinical environment, a better protocol is needed. A baseline preoperative and postoperative PAEDwould be useful to provide a comparative reference point in the recovery room and reduce the risk of falsepositive results. Routine monitoring and preoperative and postoperative PAED scores treated as vital signs in the pediatric units will yield better ED assessments and care. The best approach to reducing ED should be preventing its occurrence rather than treating the symptoms and pain with α2-adrenergic agonists. Standardized and routine monitoring of ED will ensure better understanding of the risk factors and prevention of this phenomenon leading to better delivery of care to children and faster recovery in the postoperative setting.