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

K. Mason
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引用次数: 10

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.
小儿突发性谵妄:文献综述与解读
本文考虑了自20世纪60年代首次发现出现性谵妄(ED)和出现性躁动以来的演变,以评估当前和未来在识别、治疗和预后价值方面的趋势。需要设计良好的大型前瞻性研究来评估ED的危险因素并消除混杂因素,还需要标准化的筛查、评估工具和数据共享,以便儿科ED(以哭泣、抽泣、抽搐和麻醉后定向障碍为特征)的研究人员容易比较结果。因此,出现性谵妄应被视为在儿童麻醉后恢复期持续记录的“生命体征”。儿科麻醉突发性谵妄(PAED)量表,根据表现出的行为进行评分,目前用于识别ED。由于在紧张的临床环境中评估儿童(特别是有特殊需要的儿童)的正常行为存在问题,因此需要一个更好的方案。术前和术后基线paed将有助于为恢复室提供一个比较参考点,并降低假阳性结果的风险。常规监测和术前、术后PAED评分作为儿科病房的生命体征将产生更好的ED评估和护理。减少ED的最佳方法应该是预防其发生,而不是用α2-肾上腺素能激动剂治疗症状和疼痛。ED的标准化和常规监测将确保更好地了解危险因素和预防这一现象,从而更好地为儿童提供护理,并在术后更快地恢复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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