Frequency, predictive factors and therapy of emergence delirium: data from a large observational clinical trial in a broad spectrum of postoperative pediatric patients

BACKGROUND: Emergence delirium (ED) is an important postanesthetic complication in children. Although it has been thoroughly studied, data on frequency, predictive factors, and therapy of this phenomenon are inconclusive. In this study, we seek to obtain a better understanding of the frequency of ED and different therapeutic approaches, making use of the large amount of patients in our university hospital. METHODS: After approval by the local ethics committee, patients aged zero to 13 years, who were treated in the post anesthesia care of our hospital, were investigated in this observational study. ED was diagnosed on basis of a clinical evaluation as well as with the Pediatric Anesthesia Emergence Delirium (PAED) Scale. RESULTS: In 86 of 821 patients a PAED-Score >= 10 and therefore an ED was detected (10.5%). Based on clinical assessment by the PACU staff only 5.7% experienced an ED. Age <five years (OR 2.693, 95% CI: 1.585-4.574; P<0.001), ASA physical status I (OR 1.706 95% CI: 1.057-2.753; P=0.029) and surgery in the area of head and throat (OR 2.213 95% CI: 1.446-3.387; P<0.001) were predictive factors of ED. In 24.4% of patients with PAED-Score >= 10 (21/86) an additional pharmacological therapy with clonidine and/or propofol was necessary. CONCLUSIONS: ED was less frequently diagnosed than expected. In spite of its self-limited nature, an additional pharmacological treatment was necessary in one quarter of children with ED.