Department of Anesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Paediatr Anaesth. 2020 Sep;30(9):1020-1026. doi: 10.1111/pan.13937. Epub 2020 Jun 25.
Emergence delirium is a well-described complication in pediatric anesthesia, occurring more often following short surgical procedures using volatile anesthetics with a rapid recovery profile. Dental extractions and conservation dentistry are commonly performed in children and are not painful postoperatively. The use of nerve blocks and local anesthetic infiltration intraoperatively limits nociception and obviates the need for opioids, allowing for more objective assessment of emergence delirium.
The purpose of this preliminary study was to describe the incidence of emergence delirium and the associated risk factors in children undergoing elective dental surgery under general anesthesia at a regional academic hospital in South Africa.
A prospective, descriptive study of healthy children aged 2-6 years was undertaken. Patients were anesthetized using standardized protocols. Assessments included demographics of the child and caregiver, child anxiety at induction using the modified Yale Preoperative Anxiety Scale, intraoperative events, and Paediatric Anaesthesia Emergence Delirium score in the recovery room. Data were assessed for associations and correlations.
Ninety-one children with a mean age of 3.9 (SD = 0.9) years were included. Anxiety was present in 69.2% at induction and emergence delirium occurred in 51.6% of the patients. The mean (SD, range) Paediatric Anaesthesia Emergence Delirium score in the patients without emergence delirium was 7 (2.65, 0-9) and in patients with emergence delirium was 14 (2.52, 10-18). Children with emergence delirium required more interventions in the recovery room but few required pharmacological treatment.
Emergence delirium occurs commonly after dental surgery, and the majority of the children presenting for dental surgery are anxious at induction. Children with emergence delirium require more interventions in the recovery room but few require pharmacological treatment.
在小儿麻醉中，苏醒期谵妄是一种常见的并发症，在使用具有快速恢复特征的挥发性麻醉剂进行短时间手术时更为常见。拔牙和保存牙科在儿童中很常见，术后不会疼痛。术中使用神经阻滞和局部麻醉浸润限制伤害感受，避免使用阿片类药物，从而可以更客观地评估苏醒期谵妄。
本初步研究旨在描述南非一家地区学术医院行择期牙科手术的儿童全身麻醉下苏醒期谵妄的发生率及其相关危险因素。
对 2-6 岁健康儿童进行前瞻性描述性研究。患儿采用标准化方案麻醉。评估包括患儿和照料者的人口统计学特征、使用改良耶鲁术前焦虑量表评估诱导时的患儿焦虑程度、术中事件和恢复室的小儿麻醉苏醒期谵妄评分。评估数据的相关性。
共纳入 91 名平均年龄为 3.9（标准差=0.9）岁的患儿。诱导时有 69.2%的患儿存在焦虑，51.6%的患儿出现苏醒期谵妄。无苏醒期谵妄的患儿平均（标准差，范围）小儿麻醉苏醒期谵妄评分为 7（2.65，0-9），有苏醒期谵妄的患儿为 14（2.52，10-18）。有苏醒期谵妄的患儿在恢复室需要更多的干预，但很少需要药物治疗。
牙科手术后常发生苏醒期谵妄，大多数接受牙科手术的儿童在诱导时都有焦虑。有苏醒期谵妄的患儿在恢复室需要更多的干预，但很少需要药物治疗。
