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Emergence Agitation and Emergence Delirium
Case Synopsis
An otherwise healthy 4-year-old boy undergoes general anesthesia for circumcision. The surgery proceeds without incident. When the child arrives in the postanesthesia care unit (PACU), he is noted to be restless, irritable, crying, and not responsive to routine calming measures. His agitated behavior escalates to incoherent screaming, thrashing of his extremities, and intermittent combativeness.
Problem Analysis
Definition
Emergence agitation (EA) in young children is characterized by crying, restlessness, and irritability during the emergence from anesthesia, whereas emergence delirium (ED) is a dissociated state of consciousness in which the child is hyperkinetic and incoherent, with inconsolable crying, screaming, kicking, or thrashing. It is likely that EA and ED are two manifestations of the same cognitive state.
Recognition
Emergence agitation is a common event after even minor surgery in toddlers, preschoolers, and young school-age children. An episode of emergence agitation may last 20 to 30 minutes and may not respond to routine comforting measures. Between 5% and 10% of children manifest severe symptoms that resemble delirium. Adolescents and young adults seem to have a higher incidence of delirium versus simple agitation in the PACU.
Risk Assessment
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