Emergence delirium

Emergence delirium
Classification and external resources
Specialty psychiatry
ICD-10 F13.4
ICD-9-CM 292.81

Emergence delirium (sometimes referred to as agitated emergence, emergence agitation, emergence excitement, or postanesthetic excitement) is a condition in which emergence from general anesthesia is accompanied by psychomotor agitation. Some see a relation to pavor nocturnus[1] while others see a relation to the excitement stage of anesthesia.

In children

The pediatric anesthesia emergence delirium scale may be used to measure the severity of this condition in children.[2]

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%.[3] 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.[4]

References

  1. ↑ http://www.asa2012.com/PDFs_abstracts/davidson.pdf
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ E. Card, P. Pandharipande, C. Tomes, C. Lee, J. Wood, D. Nelson, A. Graves, A. Shintani, E. W. Ely and C. Hughes (2014) Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit. Br. J. Anaesth. (2014) doi: 10.1093/bja/aeu442 First published online: December 23, 2014

Further reading

  • Smessaert A; Schehr CA; Artusio JF, Jr. (April 1960). "Observations in the immediate postanaesthesia period. II. Mode of recovery". Br J Anaesth. 32 (4): 181–5. doi:10.1093/bja/32.4.181. PMID 13831798.
  • Eckenhoff JE, Kneale DH, Dripps RD (Sep–Oct 1961). "The incidence and etiology of postanesthetic excitment. A clinical survey" (PDF). Anesthesiology. 22 (5): 667–73. doi:10.1097/00000542-196109000-00002. PMID 13889092.
  • Artusio JF, Jr. (April 1964). "Anesthesia and its immediate postoperative complications". Surg Clin North Am. 44: 493–504. PMID 14180336.
  • Vlajkovic GP, Sindjelic RP (Jan 2007). "Emergence delirium in children: many questions, few answers". Anesth. Analg. 104 (1): 84–91. doi:10.1213/01.ane.0000250914.91881.a8. PMID 17179249.
  • Lepouse C, Lautner CA, Liu L, Gomis P, Leon A (Jun 2006). "Emergence delirium in adults in the post-anaesthesia care unit". Br. J. Anaesth. 96 (6): 747–53. doi:10.1093/bja/ael094. PMID 16670111.
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