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“Emergence Delirium in Children: An update”

“Emergence Delirium in Children: An update”. A J ournal Review by Dr Daveena M. Supervised by Dr Tuan Norizan & Dr Rohani. EMERGENCE DELIRIUM.

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“Emergence Delirium in Children: An update”

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  1. “Emergence Delirium in Children: An update” A Journal Review by Dr Daveena M. Supervised by Dr Tuan Norizan & DrRohani

  2. EMERGENCE DELIRIUM • … dissociated state of consciousness in which the child is inconsolable, irritable, uncompromising or uncooperative, typically trashing, crying, moaning or incoherent… • Paranoid ideation • Don’t recognize , identify familiar or known object or person. • Generally self limiting though maybe harmful

  3. Journal: • Review article “Emergence Delirium in Children: An update” – SouhaylDahmani, HonorineDelevet and Julie Hillie • Journal review based from several studies • Diagnosing • Prevention stratergies& therapy • Pain management • Role of alpha-2-agonist

  4. Genesis

  5. Postoperative pain • Once recovered to normal state, patients did not report post operative pain • Can occur following non painful stimulus Pharmacokinetics & Phamacodynamics • Variable rate of clearance of agents from CNS – variable rate of recovery of brain function • Evident with use of fast acting volatile agents • Fuctionalconectivity network vs. the executive control network of the brain cannot coexist together in the presence of anaesthesia – confusion & agitation • Sevoflurane vs. Propofol

  6. Incidence • Varies from 2 – 80% • Seen more in younger age group • Post ENT surgeries • Post anaesthesia for imaging • Seen more in sevoflurane & desflurane use vs. halothane & isoflurane • Benefits of propofol • More evident in men • Risk factors of emergent agitation

  7. Sikich & Lerman’s PAEDS • To aid the diagnostic, a scale was developed • PaediatricAnaesthesia Emergence Delirium Scale • The sensibility and specificity analysis found an area under the curve of 76.6% with a threshold of 10 or more • Providing a sensibility of 64% & specificity of 86%

  8. Adopted from South Afr J AnaesthAnalg (SAJAA), 2011 – The agitated child in recovery.

  9. Prevention is the AIM!!

  10. Pharmacological Non pharmacological Focusing on decreasing preoperative anxiety Informing parents about method of induction, encouraging them to distract child • Propofol – 1mg/kg bolus or continuous infusion intra-op. • Fentanyl intraoperatively • Ketamine • Clonidine • Dexmedetomidine – bolus at the end 0.3mg/kg or continuously • Acetaminophen-Codeine +++ • Gabapentine preoperatively • Midazolam++ • Magnesium infusion intraoperatively

  11. Treatment • PAED Scale – aids diagnosis • To prevent intense agitation which in turn could cause self inflicted harm • Caregivers/parents calm child • Midazolam 0.1mg/kg • Propofol 1mg/kg • Fentanyl 1-2mcg/kg • Dexmedetomidine 0.3mg/kg

  12. Thank you for your kind attention!

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