Emergence Delirium

Transient state of irritation and dissociation occurring after general anaesthesia. Emergence delirium is:

• Most common in young children
  Usually 2-5, but up to 10 years of age.
• Characterised by:
  • Confusion
  • Distress
  • Physical agitation
  • Non-responsive to consolation
• Self-limiting

Epidemiology and Risk Factors

Associated factors include:

• Speed of emergence
• Nature of agent
  Volatile potentially more likely than IV agents.
• Pain
• Surgery type
  ↑ risk with:
  • ENT
  • Ophthalmological
• (Young) age
• Preoperative anxiety
• Anxiety
  • Night terrors

Diagnostic Approach and DDx

May be confounded by and confused with:

• Pain
• Emergence agitation
  Distress due to:
  • Hunger
  • Thirst
  • Pain
  • Anxiety
  • Hypoxia

Management

Parental anxiety is usually harder to manage than the child

Medical

Preventative:

• Premedication
• Ensuring adequate analgesia
  • Fentanyl
  • Ketamine
• Clonidine
• Propofol on emergence
  May slow emergence.

Established:

• Analgesia
  • Fentanyl
• Sedation
  • Propofol
  • Midazolam
• Reuniting with parent
• Waiting
  Will resolve spontaneously.

Prognosis

Emergence delirium is:

• Self-limiting
• May not occur again
• Strongly associated with amnesia
  Rare for child to recall any aspect of the delirious state.

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References

1. Reduque LL, Verghese ST. Paediatric emergence delirium. Contin Educ Anaesth Crit Care Pain. 2013 Apr 1;13(2):39–41.
2. RCH. Emergence Delirium Fact Sheet. 2019. RCH.