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Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions

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Abstract

Emergence delirium (ED) is defined as psychomotor agitation and delirium that typically occurs within 45 min from emergence of anesthesia. Preoperative patient conditions such as anxiety and confusion are risk factors for the development of postoperative ED. Common signs of ED are general non-purposeful resistive movements such as kicking, pulling, flailing as well as lack of eye contact and general lack of awareness of surroundings. The use of volatile anesthetics (VA) is contributory, while the use of total intravenous anesthetic techniques (TIVA) may help to reduce the incidence of emergence delirium. Furthermore, various pharmacologic strategies and alternatively non-pharmacologic strategies have been demonstrated to further diminish its occurrence. The objective of this manuscript is to provide a comprehensive review of anesthetic considerations for pediatric ED and to provide an update on techniques that have been found to be effective in reducing the overall risk of developing postoperative ED in pediatric patients.

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

All authors, Ivan Urits, Denzil Mathew, Jacquelin Peck, Stephen Giacomazzi, Riki Patel, John Wolf, Vwaire Orhurhu, and Omar Viswanath are responsible for conception, drafting, revision, and acceptance of the final manuscript.

Disclosures

Alan D. Kaye is a member of the journal’s editorial board. Ivan Urits, Jacquelin Peck, Stephen Giacomazzi, Riki Patel, John Wolf, Denzil Mathew, Ruben Schwartz, Hisham Kassem, Richard D. Urman, and Omar Viswanath have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Authors and Affiliations

  1. Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Ivan Urits

  2. Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA

    Jacquelin Peck, Ruben Schwartz & Hisham Kassem

  3. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Stephen Giacomazzi, Riki Patel, John Wolf, Denzil Mathew & Omar Viswanath

  4. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Richard D. Urman

  5. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Alan D. Kaye

  6. Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA

    Omar Viswanath

  7. Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Omar Viswanath

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  1. Ivan Urits
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Correspondence to Ivan Urits.

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Urits, I., Peck, J., Giacomazzi, S. et al. Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions. Adv Ther 37, 1897–1909 (2020). https://doi.org/10.1007/s12325-020-01317-x

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