Understanding And Treating Emergence Delirium

This paper examines our current understanding of the phenomena of emergence delirium, which can occur following general anesthesia. Much research has been conducted to elucidate the causative factors of this condition, with findings ranging from anxiety to volatile agents and the neurodevelopment of the brain (Aono, Ueda, & Mamiya, 1997; Kain et al., 2004; McLott, Jurecic, Hemphill, & Dunn, 2013). While much of our understanding of emergence delirium has come from studying children, who are more prone to this condition, we can attempt to learn even more by examining the increased incidence of emergence delirium that occurs in those with post-traumatic stress disorder or PTSD (Lovestrand, Phipps, & Lovestrand, 2013). Not only has our understanding of brain structure and function increased in recent years, but our improved ability to target specific receptors with pharmacological agents has also enabled us to discover ways to lessen the incidence of this upsetting and potentially dangerous response to general anesthesia (Dahmani et al., 2010). Current treatments that target GABA, opioid and alpha-2 receptors appear to demonstrate the greatest effect, however, there is wide variability within these receptor classes and various side effects that must also be considered. Individual genetic variations in receptor subtypes only complicates the picture, and may be the focus of future research as our understanding of and attention to the human genome increases. UNDERSTANDING AND TREATING EMERGENCE DELIRIUM 3 Understanding and Treating Emergence Delirium Emergence delirium, also referred to as emergence agitation and emergence excitement, is a condition that can occur following the administration of general anesthesia. This condition was first described by Dr. Eckenhoff in the 1960s, who referred to it as post anesthetic excitement and considered it a dissociated state of consciousness (Mohkamkar et al., 2014). Emergence delirium can be defined as a state of mental confusion, agitation and disinhibition marked by hyperexcitability, crying, restlessness and hallucinations during emergence from general anesthesia (Stamper, Hawks, Taicher, Bonta, & Brandon, 2014). During this period, attempts to reorient the patient through verbal and other means are ineffective. Although emergence delirium is most likely to occur during the first 30 minutes following anesthesia and tends to last for between 15 and 30 minutes, it has been reported to occur as long as 45 minutes following emergence and to last for upwards of two days in the most extreme cases (Dahmani, Delivet, & Hilly, 2004; Munk, Anderson, & Gogenur, 2013). Emergence delirium appears to effect children more often than adults, with studies showing that it occurs at rates of three to eight times greater in children (Stamper et al., 2014).