The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica
Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a c...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2014-11-01
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| Series: | Brazilian Journal of Anesthesiology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001413002054 |
| _version_ | 1818026793026715648 |
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| author | Rachel Gooden Ingrid Tennant Brian James Richard Augier Annette Crawford-Sykes Kelvin Ehikhametalor Georgiana Gordon-Strachan Hyacinth Harding-Goldson |
| author_facet | Rachel Gooden Ingrid Tennant Brian James Richard Augier Annette Crawford-Sykes Kelvin Ehikhametalor Georgiana Gordon-Strachan Hyacinth Harding-Goldson |
| author_sort | Rachel Gooden |
| collection | DOAJ |
| description | Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3–10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients’ level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145) children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9 ± 7.8 min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4 ± 11.9 versus 29.7 ± 10.8 min for non-agitated children; p < 0.001). Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2–8.6) and moderate and severe anxiety prior to induction (p < 0.001, OR 5.6, 95% CI 2.3–13.0). Complications of emergence delirium included intravenous line removal (n = 1), and surgical site bleeding (n = 3). Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%. Resumo: Justificativa e objetivos: Delírio ao despertar é uma complicação preocupante após o uso de sevoflurano em anestesia geral. Este estudo procurou determinar a incidência de delírio ao despertar e os fatores de risco em pacientes de um hospital pediátrico especializado, em Kingston, Jamaica. Métodos: Estudo transversal e observacional, incluindo pacientes pediátricos com idades entre 3-10 anos, estado físico ASA I-II, submetidos à anestesia geral com sevoflurano para procedimentos eletivos em regime ambulatorial. Os dados coletados incluíram nível de ansiedade no pré-operatório medido com a Escala de Ansiedade Pré-operatória de Yale modificada, cirurgia realizada, duração da anestesia e analgésicos administrados. No período pós-operatório, os pacientes foram avaliados para verificar a incidência de delírio ao despertar, definido como agitação com movimentos não-intencionais, inquietação ou debatimento; inconsolável e apático à presença de enfermeiros e/ou dos pais. A necessidade de tratamento farmacológico e as complicações pós-operatórias relacionadas a episódios de delírio ao despertar também foram registradas. Resultados: 145 crianças foram incluídas, com incidência de delírio ao despertar em 28 (19,3%). Os episódios de delírio ao despertar apresentaram uma média de duração de 6,9 ± 7,8 min; a intervenção farmacológica foi necessária em 19 pacientes (67,8%) e foi associada ao tempo de recuperação prolongado (49,4 ± 11,9 versus 29,7 ± 10,8 min para crianças não-agitadas; p < 0,001). Os fatores positivamente associados ao delírio ao despertar incluíram idade mais jovem (p = 0,01, OR 3,3, IC95 1,2-8,6) e ansiedade moderada e grave pré-indução (p < 0,001, OR 5.6, IC95 2,3-13,0). As complicações do delírio ao despertar incluíram a remoção da linha intravenosa (n = 1) e sangramento do sítio cirúrgico (n = 3). Conclusão: As crianças mais jovens que apresentam ansiedade séria no período pré-operatório possuem maior risco de desenvolver delírio pós-anestesia geral com sevoflurano. A incidência global de delírio foi de 19%. Keywords: Emergence delirium, Agitation, Sevoflurane, Pediatric anesthesia, Palavras-chave: Delírio de emergência, Agitação, Sevoflurano, Anestesia pediátrica |
| first_indexed | 2024-12-10T04:37:39Z |
| format | Article |
| id | doaj.art-9334686e7cd746318e6b692f19a0e7f8 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-12-10T04:37:39Z |
| publishDate | 2014-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-9334686e7cd746318e6b692f19a0e7f82022-12-22T02:01:58ZengElsevierBrazilian Journal of Anesthesiology0104-00142014-11-01646413418The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, JamaicaRachel Gooden0Ingrid Tennant1Brian James2Richard Augier3Annette Crawford-Sykes4Kelvin Ehikhametalor5Georgiana Gordon-Strachan6Hyacinth Harding-Goldson7Bustamante Hospital for Children, South East Regional Health Authority, Kingston, Jamaica; Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, JamaicaDepartment of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica; Corresponding author.Bustamante Hospital for Children, South East Regional Health Authority, Kingston, JamaicaDepartment of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, JamaicaDepartment of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, JamaicaDepartment of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, JamaicaHealth Research Resource Unit, Dean's Office, Faculty of Medical Sciences, University of the West Indies, Kingston, JamaicaDepartment of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, JamaicaBackground and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3–10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients’ level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145) children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9 ± 7.8 min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4 ± 11.9 versus 29.7 ± 10.8 min for non-agitated children; p < 0.001). Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2–8.6) and moderate and severe anxiety prior to induction (p < 0.001, OR 5.6, 95% CI 2.3–13.0). Complications of emergence delirium included intravenous line removal (n = 1), and surgical site bleeding (n = 3). Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%. Resumo: Justificativa e objetivos: Delírio ao despertar é uma complicação preocupante após o uso de sevoflurano em anestesia geral. Este estudo procurou determinar a incidência de delírio ao despertar e os fatores de risco em pacientes de um hospital pediátrico especializado, em Kingston, Jamaica. Métodos: Estudo transversal e observacional, incluindo pacientes pediátricos com idades entre 3-10 anos, estado físico ASA I-II, submetidos à anestesia geral com sevoflurano para procedimentos eletivos em regime ambulatorial. Os dados coletados incluíram nível de ansiedade no pré-operatório medido com a Escala de Ansiedade Pré-operatória de Yale modificada, cirurgia realizada, duração da anestesia e analgésicos administrados. No período pós-operatório, os pacientes foram avaliados para verificar a incidência de delírio ao despertar, definido como agitação com movimentos não-intencionais, inquietação ou debatimento; inconsolável e apático à presença de enfermeiros e/ou dos pais. A necessidade de tratamento farmacológico e as complicações pós-operatórias relacionadas a episódios de delírio ao despertar também foram registradas. Resultados: 145 crianças foram incluídas, com incidência de delírio ao despertar em 28 (19,3%). Os episódios de delírio ao despertar apresentaram uma média de duração de 6,9 ± 7,8 min; a intervenção farmacológica foi necessária em 19 pacientes (67,8%) e foi associada ao tempo de recuperação prolongado (49,4 ± 11,9 versus 29,7 ± 10,8 min para crianças não-agitadas; p < 0,001). Os fatores positivamente associados ao delírio ao despertar incluíram idade mais jovem (p = 0,01, OR 3,3, IC95 1,2-8,6) e ansiedade moderada e grave pré-indução (p < 0,001, OR 5.6, IC95 2,3-13,0). As complicações do delírio ao despertar incluíram a remoção da linha intravenosa (n = 1) e sangramento do sítio cirúrgico (n = 3). Conclusão: As crianças mais jovens que apresentam ansiedade séria no período pré-operatório possuem maior risco de desenvolver delírio pós-anestesia geral com sevoflurano. A incidência global de delírio foi de 19%. Keywords: Emergence delirium, Agitation, Sevoflurane, Pediatric anesthesia, Palavras-chave: Delírio de emergência, Agitação, Sevoflurano, Anestesia pediátricahttp://www.sciencedirect.com/science/article/pii/S0104001413002054 |
| spellingShingle | Rachel Gooden Ingrid Tennant Brian James Richard Augier Annette Crawford-Sykes Kelvin Ehikhametalor Georgiana Gordon-Strachan Hyacinth Harding-Goldson The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica Brazilian Journal of Anesthesiology |
| title | The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica |
| title_full | The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica |
| title_fullStr | The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica |
| title_full_unstemmed | The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica |
| title_short | The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica |
| title_sort | incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery kingston jamaica |
| url | http://www.sciencedirect.com/science/article/pii/S0104001413002054 |
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