Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Department of Neurology and Experimental Neurology, Campus Charité Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany.
Minerva Anestesiol. 2019 Jun;85(6):617-624. doi: 10.23736/S0375-9393.19.13038-6. Epub 2019 Jan 18.
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.
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.
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.
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.
术后谵妄（ED）是儿童麻醉后一种重要的并发症。尽管已经对此进行了深入研究，但关于这种现象的频率、预测因素和治疗的数据尚无定论。在这项研究中，我们试图通过利用我们大学医院的大量患者来更好地了解 ED 的频率和不同的治疗方法。
在获得当地伦理委员会的批准后，对在我们医院麻醉后监护病房接受治疗的 0 至 13 岁患者进行了这项观察性研究。ED 根据临床评估以及儿科麻醉苏醒期谵妄量表（PAED）进行诊断。
在 821 名患者中，有 86 名患者的 PAED 评分≥10，因此被诊断为 ED（10.5%）。根据麻醉后监护病房工作人员的临床评估，只有 5.7%的患者出现 ED。年龄<五岁（OR 2.693，95%CI：1.585-4.574；P<0.001）、ASA 身体状况 I 级（OR 1.706，95%CI：1.057-2.753；P=0.029）和头颈部手术（OR 2.213，95%CI：1.446-3.387；P<0.001）是 ED 的预测因素。在 PAED 评分≥10 的 24.4%（21/86）的患者中，需要额外使用可乐定和/或丙泊酚进行药理学治疗。
ED 的诊断频率低于预期。尽管 ED 具有自限性，但四分之一的 ED 患儿需要额外的药物治疗。
