Preventing Emerge Delirium in Children

Dr. Ivan Florentino, associate professor of anesthesiology and perioperative medicine and pediatrics at the Medical College of Georgia, said that the temporary combativeness after surgery in children is preventable with drugs that lower the epinephrine production.

The temporary combativeness after surgery is a common event that affects more than half of anesthetized children.

Dr Florentino says that “some children wake up after surgery and begin crying and become combative.

“They are often extremely frightened, disoriented and refuse to be comforted, even after being reunited with their parents.

“Some even hallucinate and become so agitated that they have to be restrained.”

This type of reaction is called emergence delirium and it can result from a brain dysfunction that rises the amount of hormones that trigger a violent reaction from the sympathetic nervous system.

The most likely to be affected are preschool-aged children and also kids with behavioral problems, because they often already have a hyperactive sympathetic nervous system, according to Florentino.

“Some types of anesthesia increase the release of the stress hormone norepinephrine in the brain,” he added.

Previous animal studies have concluded that a child who has been administrated traditional inhaled anesthetics, has more chances of expressing emergence delirium.

This disorder can be really tough for parents and post-anesthesia medical staff because children can become so nervous that they can even pull out their IVs and surgical drains and trigger complications like high bleeding at the surgical site, Dr Florentino explained.

This why preventing this problem “as much as possible is a way to improve children's experience with the operating room and anesthesia.

“People used to be simply concerned about whether the patient woke up from surgery.

“Now the practice has shifted to focus on a better experience for the patients and their families."

The solution to this are newer drugs that bind to cells that release epinephrine, which reduce the incidence if administrated before or with anesthesia.

The findings are presented at the 50th Honduran National Congress of Anesthesiology October 8-9.