Parents of children with ED frequently express concern, anxiety and dissatisfaction. Parental satisfaction is becoming an important benchmark for anaesthesia care. In addition, the care of these children often requires additional nursing staff, which can compromise staffing ability in the PACU. These children pose a risk of harming not only themselves but also the care staff in PACU. For example, children with ED can disrupt surgical repairs as a result of excessive movement they can dislodge intravenous (IV)Ĭatheters and surgical drains or tubes. These attributes can lead to both short- and longer-term negative effects on the child, parents as well as direct caregivers in the PACU. The signs and symptoms of ED include inconsolable crying, uncontrolled movements and uncooperativeness. A score of > 12 has 100 % sensitivity and 94.5 % specificity for the diagnosis of ED. A score of ≥ 10 has 64 % sensitivity and 86 % specificity for the diagnosis of ED.
The scores of each criterion are added to make a total score. The PAED scale consists of 5 criteria that are scored using a 5-point scale.
Pediatric Anaesthesia Emergence Delirium (PAED) Scale Score. 1 The incidence of ED is higher in paediatrics than that reported in the adult population (5.3 % ). This wide range results from differences in study design, methodology and interpretation. The most common consensus from the literature is an incidence of 10 % to 30 % of all children in the postanaesthesia care unit (PACU). The incidence of ED has been reported to range from 2 % to 80 %. This tutorial reviews what we currently know about ED, who is at risk for developing ED and the pharmacologic and nonpharmacologic interventions that can be used to treat it. 1 Practically, it can be challenging to accurately identify patients who are at risk for developing ED as well as preventing and treating it. The characteristics that make up ED include irritability, inconsolable crying, distress and inability to cooperate. Although often used interchangeably with emergence agitation, it is defined as a temporary dissociated state of consciousness after discontinuation of anaesthesia.
It is crucial that the anaesthesia provider review and select the most appropriate strategy for each individual patient.Įmergence delirium (ED) was first described in the literature in the early 1960s. Interventions to decrease emergence delirium include choice of anaesthetic techniques, medications and nonpharmacologic interventions.Patients who experience emergence delirium are at higher risk of developing postoperative maladaptive behaviours.Postoperative pain can confound the identification of emergence delirium.Risk factors associated with emergence delirium are age, preexisting behaviours, types of surgery and the use of volatile anaesthesia.The commonly reported incidence of emergence delirium is about 10 % to 30 % of paediatric patients.It is characterised by marked irritation and psychomotor agitation. Emergence delirium is a transient dissociated state of consciousness that occurs after discontinuation of anaesthesia.
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