Children's Strange Behaviors After Anesthesia Reassuringly Short-Lived

NEW ORLEANS -- Children coming out of general anesthesia with emergence delirium did not have lasting behavior problems in a small single-center study.

Among several dozen preschool-age children undergoing surgery with general anesthesia, those who did and did not exhibit emergence delirium had similar parent-reported behaviors such as anxiety, somatization, hyperactivity, and attention problems at 3 months, reported Amira Joseph, MD, an anesthesiology resident at the Mayo Clinic College of Medicine in Rochester, Minnesota.

"Any short-term behavior changes associated with emergence delirium noted by others are short-lived," she told the attendees at the American Society of Anesthesiologists (ASA) annual meeting.

Emergence delirium describes behaviors, such as confusion and kicking and crying, that may occur as a child awakens from anesthesia of various classes. Although some instances may result in harm -- with inadvertent removal of catheters, dressings, and drains, as well as self-harm -- emergence delirium is usually self-limited and appears to resolve spontaneously after 5 to 15 minutes.

According to the Watcha scale, emergence delirium occurred in 35% of patients in the study.

"It was previously unknown if emergence delirium affects children's behavior in the longer term," Joseph said in a press release. "Sitting in the waiting room while your child has surgery is always a distressing time for parents and it's even more upsetting watching your child come out of anesthesia displaying unusual behavior such as inconsolability, unresponsiveness, restlessness or incoherence."

"Our study provides reassurance to healthcare providers and parents of children who need surgery that there won't be behavioral issues long-term from having general anesthesia administered," she added.

During the same ASA session, pediatric anesthesiologist Andrew Davidson, MD, of the Royal Children's Hospital in Melbourne, Australia, noted that the etiology of emergence delirium remains largely unknown and is thought to be related to premature awakening, when the brain is still half-asleep.

Davidson cited several pharmacological agents that may reduce emergence delirium after general anesthesia. Non-drug options include monochromatic blue light, music therapy, and the mother's voice.

Delirium may also be avoided if the child is allowed to transition to a more typical sleep-like state, he theorized. "You don't keep poking the child," he told the audience.

For this study, Joseph and colleagues included 68 children (54% girls) with a median age of 5 years.

Parents reported children's behaviors on the Behavior Assessment System for Children-third edition (BASC-3) scale 1 week before surgery and again at 3 months post surgery.

Three-quarters of the procedures in the study had been otolaryngology surgeries, which means study results may not be generalizable to other procedures, Joseph acknowledged.

She reported that anesthesia lasted a median 75 minutes, and 62% had received a premedication.

Earlier this year, one group reported that intranasal dexmedetomidine (Precedex) outperformed midazolam as premedication for children ages 12 and younger undergoing tonsillectomy or adenoidectomy in a randomized trial. Besides the reduction in the main outcome of perioperative respiratory adverse events, there was also a significant drop in emergence delirium in that study.

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