Emergence Delirium in Pediatric Patients: Valerie Au, M.D. Andrew Infosino, M.D
Emergence Delirium in Pediatric Patients: Valerie Au, M.D. Andrew Infosino, M.D
Emergence Delirium in Pediatric Patients: Valerie Au, M.D. Andrew Infosino, M.D
Delirium in
Pediatric Patients
Updated May 2019
Behavior Score
Calm 1
Crying, can be consoled 2
Crying, cannot be consoled 3
Agitated, thrashing around 4
Eye contact 4 3 2 1 0
Purposeful
actions 4 3 2 1 0
Aware of 4 3 2 1 0
surroundings
Restless 0 1 2 3 4
Inconsolable 0 1 2 3 4
• Reassure parents
• Educate PACU nurses and parents
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Emergence Delirium:
Treatment
If emergence delirium persists in the
PACU consider IV bolus of either:
• Dexmedetomidine (0.2-0.4 mcg/kg)
• Propofol (1-2 mg/kg)
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Conclusions
• ED is a complex behavioral state that is poorly
understood
• ED is difficult to distinguish from agitation/pain
• PAED is best current assessment tool for ED
• Propofol based anesthetic with Dexmedetomidine
is best approach to decrease the incidence of ED in
high risk cases
• Consider Dexmedetomidine or Propofol IV bolus to
manage ED in PACU
References:
References:
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prevention of emergence agitation in children having strabismus surgery. Anesthesiology 2014; 210: 1354-61
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References:
References (cont.):
12. Lee CJ et al. The effect of Propofol on emergence agitation in children receiving sevoflurane for
adenotonsillectomy. Korean J Anesthesiol 2010:59:75-81
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adrenergic agonists on postoperative behavior in children. . Br J Anaesth 2014;
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sevoflurane anesthesia: Meta-analysis of Randomized Controlled Trials. Plos One 2015 10:e0135244
15. Van Hoff SL, O’Neill ES, Cohen LC, Collins BA. Does a prophylactic dose of Propofol reduce emergence agitation
in children receiving anesthesia? A systematic review and meta-analysis. Paediatr Anaesth 2015; 25:668-76
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sevoflurane anesthesia: a meta-analysis of randomized controlled trials. PLoS ONE 2014; 16:e99718
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