Predisposing factors of emergence agitation in pediatric anesthesia

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand | 2019 Objective: To identify pre-operative and intra-operative predictors of emergence agitation or delirium in pediatric patients after general anesthesia. Materials and Methods: After IRB approval, the present study conducted a single-center, prospective, observational cohort study that included 607 patients, between the age of 2 and 21 years, undergoing elective ambulatory surgery between August 2013 and May 2014. The collected data was pre-operative demographics, anesthetic techniques, surgical procedures, and post anesthesia outcomes (including pain and agitation or delirium). The agitation or delirium was defined by the Pediatric Anesthesia Emergence Delirium (PAED) scale score of 10 or more lasting longer than 10 minutes in the post anesthesia care unit (PACU). A multivariable binary logistic regression model was generated, and the performance of the multivariable model was evaluated by the c statistic. Results: Among the 429 patients with agitation data, 170 (39.6%) had high agitation score (scores of 10 or more) (95% confidence interval 35% to 44%). Univariate logistic regression model showed that age, weight of less than 20 kg and tonsillectomy and adenoidectomy (Tanda) surgery were predictors of agitation. The utilization of intra-operative propofol, dexmedetomidine, or midazolam decreased agitation. Applying multivariate logistic regression modeling revealed that age between two and six years and Tanda surgery were independent predictors of agitation. Conclusion: The present prospective observation trial found that age and surgery type were independent predictors of agitation or delirium during recovery in children after surgery. Further study needs to focus on how to prevent post-operative agitation or delirium in the high-risk population.