Emergence Agitation and Delirium: Considerations for Epidemiology and Routine Monitoring in Pediatric Patients

Abstract

Carrie Menser,1 Heidi Smith1,2 1Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; 2Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USACorrespondence: Carrie MenserDepartment of Anesthesiology, Vanderbilt University Medical Center, 2200 Children’s Way Suite 3115, Nashville, TN 37232, USATel [phone]Fax [phone]Email [email protected]: Emergence from anesthesia can be associated with a wide spectrum of cognitive and behavioral dysregulation in children, including delirium or acute brain dysfunction. This period of neurobehavioral recovery can be further confounded by pain, anxiety, and fear. The implementation of monitoring for level of consciousness, pain, and delirium using valid pediatric tools is necessary to avoid misdiagnosis due to overlapping symptomatology and support appropriate management. Understanding the epidemiology of delirium in the postoperative setting will require consistent use of accurate terminology in the medical literature. The current interchangeable use of the terms “emergence agitation” and “emergence delirium” needs to be highlighted and awareness of differences in patient conditions and assessment tools is essential. We discuss epidemiology of emergence agitation and delirium in the pediatric population, and the challenges for future delineation of monitoring and management. Furthermore, we describe the possible impact of long-term consequences of emergence delirium among infants and children, and the necessary areas of future research.Keywords: emergence, delirium, agitation, excitation, pediatrics, postoperative, sedation, perioperative

Keywords

• emergence
• delirium
• agitation
• excitation
• pediatrics
• postoperative
• sedation
• perioperative