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Emergence agitation or delirium in children

The Original Article was published on 07 November 2019

To the Editor:

In recent article of Cho et al. [1], comparing two drugs for prevention of emergence delirium (ED) in children, we noted several issues that needed further clarification. First, ED determined using a four-point agitation scale was best called as emergence agitation, as they do not meet the diagnostic criteria of delirium in the DSM-5 required by 2018 newest recommendations for nomenclature of cognitive change associated with anesthesia and surgery [2]. Second, this only used PAED scale to quantify severity of ED, but not to identify ED. As an ideal and valid rating tool, PAED scale has been widely accepted to identify and quantify ED in children; i.e., a score ≥ 10 has 64% sensitivity and 86% specificity, and a score > 12 has 100% sensitivity and 94.5% specificity for diagnosing ED. Third, postoperative pain score differ significantly between groups, but postoperative analgesic data were not provided and compared. As postoperative pain is a known precipitating factor for ED in children, we were concerned that unbalanced postoperative pain treatments would have biased their findings. Fourth, because of a small sample, this study has no enough power to determine significant differences in the four-point agitation scale, PAED score and incidence of severe ED among various age children. Fifth, preoperative anxiety levels should be present as median with a range and compared between groups.

References

  1. 1.

    Cho EA, Cha YB, Shim JG, Ahn JH, Lee SH, Ryu KH. Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial. J Anesth. 2020;34:59–655.

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  2. 2.

    Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, Oh ES, Crosby G, Berger M, Eckenhoff RG, Nomenclature Consensus Working Group. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology. 2018;129:872–9.

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All authors have no financial support and potential conflicts of interest for this work.

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Correspondence to Fu-Shan Xue.

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Cho EA, et al. Comparison of single minimum dose administration of dexmedetomidine and midazolam for prevention of emergence delirium in children: a randomized controlled trial. J Anesth. 2020; 34:59–65.

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Zou, Y., Liu, SH. & Xue, FS. Emergence agitation or delirium in children. J Anesth (2020). https://doi.org/10.1007/s00540-020-02785-9

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Keywords

  • Emergence delirium
  • Emergence agitation
  • Children