Abstract:
Introduction: Emergence delirium (ED) is described as a motor agitation state with restlessness, and disorientation, thrashing around and shouting or screaming. [1] The average, estimated incidence of emergence delirium ranges between 20-80%. [2] Multiple factors pertaining to the patient, anaesthesia and surgery are known to increase the risk of emergence delirium. The aim and objectives of this study was to assess the incidence of ED in paediatric patients undergoing elective surgeries under general anaesthesia using sevoflurane for induction and isoflurane for maintenance of anaesthesia and to identify risk factors for ED.
Methods: The study was started after obtaining consent from Institutional review board and registering in clinical trial registry. The prospective observational study was carried out on 150 children between the ages of 2 and 12 years who were posted for elective surgeries. Induction was done with oxygen and sevoflurane and was changed to isoflurane for maintenance. Post operatively, emergence delirium was assessed with Paediatric Anaesthesia Emergence Delirium (PAED) score at 15 minutes interval along with FLACC score for pain.
Results: The incidence of ED in our study population was 28.18%(n=42). Among the children who developed emergence delirium 73.8% were in the age group of 2-6 years, 85% were males, 63% had parental presence and 92.8% received no pre-medication. The mean FLACC score was 0.76+/-2.02 and patients with emergence delirium had FLACC score <4. The mean duration spent in PACU was 130 mins for children with emergence delirium and 96 mins (p=0.0003) in children who did not manifest emergence delirium.
Discussion: This prospective observational trial has shown that the incidence of emergence delirium in our population was 28.19% when sevoflurane was used for induction followed by isoflurane as a maintenance agent. This incidence is much lesser as compared to 40% when sevoflurane is used both for induction and maintenance. Previous studies reporting emergence delirium have not considered evaluating pain scores separately, to differentiate between pain and ED, which is a major limitation in these studies. In our study, FLACC score for patients with PAED SCORE>10 was zero. So, we could conclusively rule out post operative pain in our patients.
Conclusion: The judicious use of sevoflurane, age-appropriate premedication, distraction techniques and limiting fasting duration helps in avoiding ED. Using FLACC scoring system with PAED score can help in differentiating pain from emergence delirium and treat accordingly.
