The impact of postoperative cartoon viewing on emergence delirium in young children: A randomized controlled trial

Background: Research has revealed non-pharmacological methods mitigate the occurrence of emergence delirium with a lower incidence of negative side effects, but the mechanism remains unclear. This study aimed to investigate whether postoperative cartoon viewing after awakening from sevoflurane anesthesia in the postanesthesia care unit reduces the incidence of emergence delirium in young children, and to examine relevant electroencephalography findings. Methods: This was a single-center, randomized controlled trial. One hundred thirty-eight children aged 2-7 years who underwent elective tonsillectomy and/or adenoidectomy under sevoflurane anesthesia and who were classified as American Society of Anesthesiologists physical status I or II were included. Patients were randomized to receive a standard recovery protocol (control group) or to view a cartoon video (cartoon group) after awakening from anesthesia in the postanesthesia care unit. The primary outcome was the incidence of emergence delirium. The secondary outcomes included the Pediatric Anesthesia Emergence Delirium Scale, Watcha Scale, and the Faces, Legs, Activity, Cry, and Consolability Scale scores; side effects; length of stay; differences in frontal electroencephalographic asymmetry measured in the postanesthesia care unit; and post hospitalization behavior questionnaire for ambulatory surgery scores. Results: The incidence of emergence delirium in the postanesthesia care unit was lower in the cartoon group (n = 69) than in the control group (n = 69) (8.7 % vs. 26.1 %, p = 0.012). In addition, the Pediatric Anesthesia Emergence Delirium Scale scores at 5 (median difference = 2, 95 % confidence interval 1 to 3, p < 0.001), 15 (median difference = 1, 95 % confidence interval 0 to 2, p < 0.001) and 25 min (median difference = 1, 95 % confidence interval 0 to 1, p < 0.001), as well as the maximal score (median difference = 2, 95 % confidence interval 1 to 3, p < 0.001), were greater in the control group than in the cartoon group. Eighty stable electroencephalography datasets revealed frontal asymmetry differences before and after awakening, which were lower (median difference = - 1.208, 95 % confidence interval -1.450 to - 0.965, p <0.001) in the control group (n = 41) than in the cartoon group (n = 39) and moderately negatively correlated with emergence delirium (r = -0.30, p = 0.014). Conclusions: Young children who viewed a cartoon video after awakening from sevoflurane anesthesia in the postanesthesia care unit demonstrated a lower incidence of emergence delirium. A considerable difference in frontal electroencephalographic asymmetry may help to explain this effect. Registration: This trial was registered at Chinese Clinical Trial Registry (www.chictr.org.cn; ChiCTR2300073195. Registered 04/07/2023, first recruitment 05/07/2023).