Paeds

Question 1

Define emergence delirium in paediatrics

Answer 1

‘Dissociated state of consciousness in which the child is

• irritable
• uncompromising
• uncooperative
• incoherent
• inconsolably crying
• moaning
• kicking or thrashing’

Question 2

What are the potential risk factors for emergence delerium in paediatrics

Answer 2

Anaesthetic/surgical factors

• Rapid emergence from anaesthesia
• Use of short-acting volatile as (sevo>halo)
• Postoperative pain
• Surgery type (Otorhinolaryngological / ophthalmological)

Child factors

• Age (2-5y)
• Preoperative anxiety
• Child temperament (more emotional/ impulsive, less social/adaptable to enviro changes)

Question 3

What prophylactic measures might you take to limit the incidence of emergence delerium?

Answer 3

• Propofol (bolus of 1 mg/kg @ end surg/continuous infusion during surg)
• Ketamine
• a 2-Adreno-receptor agonist
• Fentanyl
• Perioperative analgesia

Question 4

Treatment options for emergence delerium

Answer 4

Question 5

Measurement scales (3) proposed to evaluate the incidence and severity of emergence delerium in paediatrics

Answer 5

• Cravero scale - 5 steps from obtunded and unresponsive to wild thrashing behaviour requiring restraint. Scores > 4/5 (crying/diffic to console/wild thrashing) for a 5 or more min duration despite active calming efforts⇒ indicative of ED.
• The Paediatric Anaesthesia Emergence Delirium (PAED) scale - validated but difficult to use in routine clinical practice.
• The Watcha scale - simpler tool for in clinical practice +/-Î overall sensititivity/specificity

Question 6

Adverse effects of emergence delerium

Answer 6

INCREASE incidence of new-onset postoperative maladaptive behaviour changes such as

• general anxiety
• night-time crying
• enur- esis
• separation anxiety
• temper tantrums

for up to 14 days after surgery