Bong Choon L, Ng Agnes S B
Department of Pediatric Anesthesia, KK Women's and Children's Hospital, Singapore.
Paediatr Anaesth. 2009 Jun;19(6):593-600. doi: 10.1111/j.1460-9592.2009.03024.x.
Emergence delirium (ED) is a common problem in children recovering from general anesthesia. ED causes disruption in the postanesthetic care unit, making nursing and monitoring more difficult, and is potentially dangerous to the child. The greatest hindrance to understanding ED was the lack of a standardized tool to assess it. The Pediatric Anesthesia Emergence Delirium (PAED) Scale was recently described to measure the degree of ED in children. In this prospective observational study, we sought to evaluate the incidence of ED by grading emergence behavior using the PAED Score in healthy Asian children undergoing outpatient surgery.
Three hundred sixteen children aged 2-12 years undergoing general anesthesia for elective outpatient surgery were included. No premedication was administered. Induction behavior was graded using the induction compliance checklist, and the presence of any excitation on induction documented. Emergence behavior was recorded using the PAED Scale, and the children were separately assessed for clinical agitation.
One hundred and thirty-six children (43%) had PAED Scores >0 and 33 (10.4%) had PAED Scores of >or=10. Only 28 children (8.9%) had clinical agitation consistent with ED, the rest were agitated for other reasons. A score of >or=10 on the PAED Scale was the best discriminator between presence and absence of clinical agitation. The area under the receiver operating characteristic curve for PAED Score of >or=10 was 0.98, with a true-positive rate (sensitivity) of 0.85 and a false-positive rate (1-specificity) of 0.041. Four factors were found to be predictive of ED. These include young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening.
The incidence of ED is approximately 10% in our population of healthy, unpremedicated Asian children undergoing day surgery. Young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening were predictive risk factors for ED in our population. A PAED Score of >or=10 was correlated with clinically significant ED and appeared to be the ideal cutoff score for ED.
苏醒期谵妄（ED）是接受全身麻醉的儿童术后常见问题。ED会干扰麻醉后护理单元的工作，增加护理和监测难度，且对儿童有潜在危险。了解ED的最大障碍是缺乏评估它的标准化工具。儿科麻醉苏醒期谵妄（PAED）量表最近被用于测量儿童ED的程度。在这项前瞻性观察研究中，我们试图通过使用PAED评分对接受门诊手术的健康亚洲儿童的苏醒行为进行分级，来评估ED的发生率。
纳入316名年龄在2至12岁、接受择期门诊手术全身麻醉的儿童。未给予术前用药。使用诱导依从性检查表对诱导行为进行分级，并记录诱导时是否存在任何兴奋情况。使用PAED量表记录苏醒行为，并分别评估儿童的临床躁动情况。
136名儿童（43%）的PAED评分>0，33名儿童（10.4%）的PAED评分≥10。只有28名儿童（8.9%）有与ED相符的临床躁动，其余儿童因其他原因躁动。PAED量表评分≥10是有无临床躁动的最佳鉴别指标。PAED评分≥10时，受试者工作特征曲线下面积为0.98，真阳性率（敏感性）为0.85，假阳性率（1-特异性）为0.041。发现有四个因素可预测ED。这些因素包括年龄小、诱导时依从性差、术中未使用芬太尼以及苏醒时间快。
在我们这群接受日间手术的健康、未使用术前用药的亚洲儿童中，ED的发生率约为10%。年龄小、诱导时依从性差、术中未使用芬太尼以及苏醒时间快是我们研究人群中ED的预测风险因素。PAED评分≥10与具有临床意义的ED相关，似乎是ED的理想临界值。
