Emergence delirium (ED) is defined as psychomotor agitation and delirium that typically occurs within 45 min from emergence of anesthesia. Preoperative patient conditions such as anxiety and confusion are risk factors for the development of postoperative ED. Common signs of ED are general non-purposeful resistive movements such as kicking, pulling, flailing as well as lack of eye contact and general lack of awareness of surroundings. The use of volatile anesthetics (VA) is contributory, while the use of total intravenous anesthetic techniques (TIVA) may help to reduce the incidence of emergence delirium. Furthermore, various pharmacologic strategies and alternatively non-pharmacologic strategies have been demonstrated to further diminish its occurrence. The objective of this manuscript is to provide a comprehensive review of anesthetic considerations for pediatric ED and to provide an update on techniques that have been found to be effective in reducing the overall risk of developing postoperative ED in pediatric patients.
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All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
All authors, Ivan Urits, Denzil Mathew, Jacquelin Peck, Stephen Giacomazzi, Riki Patel, John Wolf, Vwaire Orhurhu, and Omar Viswanath are responsible for conception, drafting, revision, and acceptance of the final manuscript.
Alan D. Kaye is a member of the journal’s editorial board. Ivan Urits, Jacquelin Peck, Stephen Giacomazzi, Riki Patel, John Wolf, Denzil Mathew, Ruben Schwartz, Hisham Kassem, Richard D. Urman, and Omar Viswanath have nothing to disclose.
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Urits, I., Peck, J., Giacomazzi, S. et al. Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions. Adv Ther 37, 1897–1909 (2020). https://doi.org/10.1007/s12325-020-01317-x
- Emergence agitation
- Emergence delirium
- Post anesthetic excitement