Emergence delirium - Misplaced Pages

Medical condition

Emergence delirium
Other names	Agitated emergence, emergence agitation, emergence excitement, postanesthetic excitement
Specialty	Anesthesia
Symptoms	Auditory and Visual Hallucinations; uncontrollable screaming, crying, panic attacks; and uncontrollable body movements
Usual onset	ranges from immediately on awakening to weeks later
Duration	few minutes to months

Emergence delirium is a condition in which emergence from general anesthesia is accompanied by psychomotor agitation. Some see a relation to pavor nocturnus while others see a relation to the excitement stage of anesthesia.

Children

The Pediatric Anesthetic Emergence Delirium (PAED) scale or the Cornell Assessment of Pediatric Delirium may be used to measure the severity of this condition in children. In this patient population, emergence delirium is typically identified within the first 30 minutes of recovery from anesthesia. It terminates within five to fifteen minutes with spontaneous resolution.

Emergence delirium occurs with similar frequency after anesthesia with desflurane and isoflurane. It has been hypothesized that rapid awakening from these inhaled anesthetics may worsen the child's natural apprehension upon suddenly finding him/herself in an unfamiliar environment.

ED in children has been associated with the type of surgery, anesthesia, and the use of adjunct medication, but the identification of its underlying cause remains elusive.

Elderly

Elderly people are more likely to experience confusion or problems with thinking following surgery, which can occur up to several days postoperatively. These cognitive problems can last for weeks or months, and can affect the patients’ ability to plan, focus, remember, or undertake activities of daily living. A review of intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery showed little or no difference in postoperative delirium according to the type of anaesthetic maintenance agents from five studies (321 participants). The authors of this review were uncertain whether maintenance of anaesthesia with propofol-based total intravenous anaesthesia (TIVA) or with inhalational agents can affect incidences of postoperative delirium. Emergence delirium has been associated long-term changes neurocognitive dysfunction after cardiac surgery.

A cohort study which included 560 adults aged 70 years and older for a period of 6 years revealed that delirium represents the most common post-operative complication and is associated with long-term cognitive decline and increased incidence of dementia.

Epidemiology

The overall incidence of emergence delirium is 5.3%, with a significantly greater incidence (12–13%) in children. The incidence of emergence delirium after halothane, isoflurane, sevoflurane or desflurane ranges from 2–55%. Most emergence delirium in the literature describes agitated emergence. Unless a delirium detection tool is used, it is difficult to distinguish if the agitated emergence from anesthesia was from delirium or pain or fear, etc. A research study of 400 adult patients emerging from general anesthesia in the PACU were assessed for delirium using the Confusion Assessment Method for the ICU (CAM-ICU) found rates of emergence delirium of 31% at PACU admission with rates declining to 8% by 1 hour.

References

"Archived copy" (PDF). www.asa2012.com. Archived from the original (PDF) on 25 January 2020. Retrieved 13 January 2022.{{cite web}}: CS1 maint: archived copy as title (link)
Sikich, N; Lerman, J (2004). "Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale". Anesthesiology. 100 (5): 1138–45. doi:10.1097/00000542-200405000-00015. PMID 15114210. S2CID 25599011.
Traube, C.; Silver, G.; Kearney, J.; Patel, A.; Atkinson, T. M.; Yoon, M. J.; Halpert, S.; Augenstein, J.; Sickles, L. E.; Li, C.; Greenwald, B. (2014). "Cornell Assessment of Pediatric Delirium: A valid, rapid, observational tool for screening delirium in the PICU". Critical Care Medicine. 42 (3): 656–663. doi:10.1097/CCM.0b013e3182a66b76. PMC 5527829. PMID 24145848.
^ Vlajkovic, Gordana P.; Sindjelic, Radomir P. (2007). "Emergence Delirium in Children: Many Questions, Few Answers". Anesthesia & Analgesia. 104 (1): 84–91. doi:10.1213/01.ane.0000250914.91881.a8. PMID 17179249. S2CID 7315961.
Lo, S. S.; Sobol, J. B.; Mallavaram, N.; Carson, M.; Chang, C.; Grieve, P. G.; Emerson, R. G.; Stark, R. I.; Sun, L. S. (2009). "Anesthetic-specific electroencephalographic patterns during emergence from sevoflurane and isoflurane in infants and children". Pediatric Anesthesia. 19 (12): 1157–1165. doi:10.1111/j.1460-9592.2009.03128.x. PMID 19708912. S2CID 23663252.
Welborn, Leila G.; Hannallah, Raafat S.; Norden, Janet M.; Ruttimann, Urs E.; Callan, Clair M. (November 1996). "Comparison of Emergence and Recovery Characteristics of Sevoflurane, Desflurane, and Halothane in Pediatric Ambulatory Patients". Anesthesia & Analgesia. 83 (5): 917–920. doi:10.1213/00000539-199611000-00005. PMID 8895263.
Miller, David; Lewis, Sharon R; Pritchard, Michael W; Schofield-Robinson, Oliver J; Shelton, Cliff L; Alderson, Phil; Smith, Andrew F (21 August 2018). "Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery". Cochrane Database of Systematic Reviews. 2018 (8): CD012317. doi:10.1002/14651858.CD012317.pub2. PMC 6513211. PMID 30129968.
Saczynski, J. S.; Marcantonio, E. R.; Quach, L.; Fong, T. G.; Gross, A.; Inouye, S. K.; Jones, R. N. (2012). "Cognitive Trajectories after Postoperative Delirium". The New England Journal of Medicine. 367 (1): 30–39. doi:10.1056/NEJMoa1112923. PMC 3433229. PMID 22762316.
Kunicki, Zachary J.; Ngo, Long H.; Marcantonio, Edward R.; Tommet, Douglas; Feng, Yi; Fong, Tamara G.; Schmitt, Eva M.; Travison, Thomas G.; Jones, Richard N.; Inouye, Sharon K. (2023). "Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium". JAMA Internal Medicine. 183 (5): 442–450. doi:10.1001/jamainternmed.2023.0144. PMC 10028541. PMID 36939716.
Mason, LJ (2004). "Pitfalls of Pediatric Anesthesia: Emergence Delirium" (PDF). Richmond, Virginia: Society for Pediatric Anestheisa. Archived from the original (PDF) on 2016-03-27. Retrieved 2012-06-21.
Card, E.; Tomes, C.; Lee, C.; Wood, J.; Nelson, D.; Graves, A.; Shintani, A.; Ely, E.W.; Hughes, C.; Pandharipande, P. (2015). "Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit". British Journal of Anaesthesia. 115 (3): 411–417. doi:10.1093/bja/aeu442. PMC 4533730. PMID 25540068.

External links

Classification	D ICD-10: F13.4 ICD-9-CM: 292.81 MeSH: D000071257

v t e Anesthesia and anesthesiology
Types	General Sedation Procedural sedation and analgesia Twilight anesthesia Local Continuous wound infiltration Topical Neuraxial blockade Combined spinal and epidural anaesthesia Epidural anesthesia Spinal anaesthesia Nerve block Brachial plexus block Fascia iliaca block Femoral nerve block Inferior alveolar nerve block Intercostal nerve block Interpleural block Intravenous regional anesthesia Occipital nerve block Paracervical block Pudendal nerve block Retrobulbar block Sciatic nerve block Transverse abdominis plane block Total intravenous anaesthesia
Pharmacologic agents	Anticholinergics Antiemetics Butyrophenones Benzodiazepines General anesthetics Inhalational anesthetics Local anesthetics Neuromuscular-blocking drugs Opioids Sedatives
Techniques	Airway management Anesthesia provision in the US Bronchoscopy Dogliotti's principle Intravenous therapy Laryngoscopy Tracheal intubation Rapid sequence induction
Scientific principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect
Measurements	ASA physical status classification system Baricity Bispectral index Body mass index Capnography Entropy monitoring Fick principle Goldman index Guedel's classification Intraoperative neurophysiological monitoring Mallampati score Neuromuscular monitoring Pain scale Thyromental distance
Instruments	Anaesthetic machine Anesthetic vaporizer Arterial catheter Bronchial blocker Double-lumen endobronchial tube Gas cylinder Laryngeal mask airway Laryngeal tube Magill forceps Relative analgesia machine Tracheal tube
Complications	Allergic reactions Anesthesia awareness Drug-induced amnesia Effects of early-life exposures to anesthesia on the brain Emergence delirium Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization
Subspecialties	Cardiothoracic Critical emergency medicine Geriatric Intensive care medicine Obstetric Oral sedation dentistry Pain medicine
Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating department practitioners Certified anesthesia technician Certified anesthesia technologist Anaesthetic technician Physicians' assistant (anaesthesia)
History	ACE mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation
Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Royal College of Anaesthetists Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society European Society of Anaesthesiology and Intensive Care
Category Outline

Category:

Anesthesia

Children

Elderly

Epidemiology

References

Further reading

External links