Postoperative emergence delirium in children: a narrative review of recent publications

Background: Emergence delirium is a challenge in pediatric anesthesiology, with important unanswered questions concerning incidence, causation, diagnosis, treatment, and sequelae. In this review, we will present the recent research particular focus placed on treatment prevention options. Methods: A wide literature search was conducted across MEDLINE other databases using PubMed, Embase, Ovid, Cochrane Library (latest access: 23 November 2020). The collected publications were assessed for relevance. Only randomized controlled trials observational studies postoperative emergence children included. Exclusion criteria articles published before 2018, comprising older than 12 years of age, mental retardation, or chronic diseases. Results: final number included review 44. Risk factors identified volatile inhalation anesthetics, young child temperament, preoperative anxiety, male gender, specific surgical procedures. Preventive and/or intervention measures pharmacological (e.g. TIVA, α2-adrenergic agonists (particularly dexmedetomidine), ketamine, propofol, midazolam, opioids (fentanyl)) non-pharmacological video tablet distraction, familiarization operating environment, use mother’s voice, visual preconditioning eye surgery). Conclusion: ED should be considered “vital sign” recorded documented all PACU. There an urgent need future to fill missing gaps knowledge regarding ED. Implementation standardized validated screening tool are high priorities as impact perioperative monitoring at risk prevent