Emergence delirium after use of sevofluranein children
Authors:
Mixa Vladimír 1; Klimovič Michal 2
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. LF UK a FN Motol, Praha
1; Klinika dětské anestézie a resuscitace, LF MU a FN Brno
2
Published in:
Anest. intenziv. Med., 24, 2013, č. 6, s. 385-390
Category:
Anesthesiology - Review Article
Overview
Emergence delirium (ED) is a state of agitation, perceptual disorders and excitation of a child after inhalational anaesthesia. It occurs in 25–55 % of paediatric anae-sthetics. Its duration depends on the chosen anaesthetic drugs, nature of the child, environment and many other factors. Most often, ED occurs in children of the age between 1 and 6 years. The pre-requisite for assessment of child’s agitation after anaesthesia as ED is assurance of adequate postoperative analgesia. The Paediatric Anaesthesia Emergence Delirium score (PAED) was designed for objective determination of ED and assessment of its seriousness.
The causes of ED have not been determined yet. Origination of postoperative confusion is attributed to rapid waking up from inhalational anaesthesia. A direct effect of sevoflurane on the central nervous system is also considered. Occurrence of ED is made more likely by emotional immaturity of the child, his/her temperament and anxiousness or calmness of the persons present. It appears that mono-anae-sthesia by sevoflurane and combined anaesthesia increase ED incidence. ED incidence is also increased by high concentration of sevoflurane at the end of anaesthesia. The most frequent occurrence of ED is in children from the infant age to preschool age of either gender. ED occurrence can be prevented by effective sedative premedication (e.g. midazolam 0.3–0.5 mg p.o.). We see less frequent occurrence of ED after balanced anaesthesia, during which mainly sufentanil was administered. If ED occurs we most often manage it by administering midazolam i.v. (0.1 mg/kg) or propofol (0.5 mg/kg i.v.) or rarely by ketamine (1 mg/kg i.v.). In the ward setting, chloral hydrate can be used. Agitation or emergence delirium in a child after sevo-flurane anaesthesia is quite a frequent complication with varied clinical manifestations.
Keywords:
emergence delirium – sevoflurane – paediatric anaesthesia – PAED score – midazolam – propofol – ketamine
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2013 Issue 6
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