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“Emergence Delirium in Children: An update” A Journal Review by Dr Daveena M. Supervised by Dr Tuan Norizan & Dr Rohani.

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Presentation on theme: "“Emergence Delirium in Children: An update” A Journal Review by Dr Daveena M. Supervised by Dr Tuan Norizan & Dr Rohani."— Presentation transcript:

1 “Emergence Delirium in Children: An update” A Journal Review by Dr Daveena M. Supervised by Dr Tuan Norizan & Dr Rohani

2 EMERGENCE DELIRIUM … dissociated state of consciousness in which the child is inconsolable, irritable, uncompromising or uncooperative, typically trashing, crying, moaning or incoherent… Paranoid ideation Don’t recognize, identify familiar or known object or person. Generally self limiting though maybe harmful

3 Journal: Review article “Emergence Delirium in Children: An update” – Souhayl Dahmani, Honorine Delevet and Julie Hillie Journal review based from several studies Diagnosing Prevention stratergies & therapy Pain management Role of alpha-2-agonist

4 Genesis Emergence Delirium Postoperative Pain Pharmacokinetics Pharmacodynamics

5 Postoperative pain Once recovered to normal state, patients did not report post operative pain Can occur following non painful stimulus Pharmacokinetics & Phamacodynamics Variable rate of clearance of agents from CNS – variable rate of recovery of brain function Evident with use of fast acting volatile agents Fuctional conectivity network vs. the executive control network of the brain cannot coexist together in the presence of anaesthesia – confusion & agitation Sevoflurane vs. Propofol

6 Incidence Varies from 2 – 80% Seen more in younger age group Post ENT surgeries Post anaesthesia for imaging Seen more in sevoflurane & desflurane use vs. halothane & isoflurane Benefits of propofol More evident in men Risk factors of emergent agitation

7 Sikich & Lerman’s PAEDS To aid the diagnostic, a scale was developed Paediatric Anaesthesia Emergence Delirium Scale The sensibility and specificity analysis found an area under the curve of 76.6% with a threshold of 10 or more Providing a sensibility of 64% & specificity of 86%

8 Adopted from South Afr J Anaesth Analg (SAJAA), 2011 – The agitated child in recovery.

9 Prevention is the AIM!! Pharmacological Prevention Non- pharmacological Prevention

10 Pharmacological Propofol – 1mg/kg bolus or continuous infusion intra-op. Fentanyl intraoperatively Ketamine Clonidine Dexmedetomidine – bolus at the end 0.3mg/kg or continuously Acetaminophen-Codeine +++ Gabapentine preoperatively Midazolam++ Magnesium infusion intraoperatively Non pharmacological Focusing on decreasing preoperative anxiety Informing parents about method of induction, encouraging them to distract child

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12 Treatment PAED Scale – aids diagnosis To prevent intense agitation which in turn could cause self inflicted harm Caregivers/parents calm child Midazolam 0.1mg/kg Propofol 1mg/kg Fentanyl 1-2mcg/kg Dexmedetomidine 0.3mg/kg

13 Thank you for your kind attention!


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