Wild Child in the PACU: Update on Emergence Agitation

Introduction Though postoperative excitement has been a feature of general anesthesia since before the development of most of our modern inhalational anesthetics, the number of studies examining the incidence of postoperative agitation has increased exponentially since the introduction of the poorly soluble inhalation agents sevoflurane and desflurane into routine anesthesia practice. Eckenhoff first described the phenomenon of emergence delirium in 1961. (1) In a review of 14, 436 postoperative patients he found four factors to be associated with a statistically higher incidence of emergence agitation: 1) children 3 – 9 years (13%), 2) cyclopropane or ether anesthesia, 3) tonsillectomy, and 4) barbiturate premedication. He also found that the incidence of emergence reactions was reduced in patients who had received intraoperative opioids. Though cyclopropane and ether anesthetics are no longer used, recent studies have confirmed the accuracy of many of Eckenhoff’s earlier observations as causative factors for emergence phenomena.