Emergence delirium

Emergence delirium
Classification and external resources
Specialty	psychiatry
ICD-10	F13.4
ICD-9-CM	292.81

Emergence delirium (sometimes referred to as agitated emergence, emergence agitation, emergence excitement, or postanesthetic excitement) is a condition in which emergence from general anesthesia is accompanied by psychomotor agitation. Some see a relation to pavor nocturnus^[1] while other see a relation to the excitement stage of anesthesia.

In children

The pediatric anesthesia emergence delirium scale may be used to measure the severity of this condition in children.^[2]

Epidemiology

The overall incidence of emergence delirium is 5.3%, with a significantly greater incidence (12–13%) in children. The incidence of emergence delirium after halothane, isoflurane, sevoflurane or desflurane ranges from 2–55%.^[3] Most emergence delirium in the literature describes agitated emergence. Unless a delirium detection tool is used, it is difficult to distinguish if the agitated emergence from anesthesia was from delirium or pain or fear, etc. A research study of 400 adult patients emerging from general anesthesia in the PACU were assessed for delirium using the Confusion Assessment Method for the ICU (CAM-ICU) found rates of emergence delirium of 31% at PACU admission with rates declining to 8% by 1 hour.^[4]

References

↑ http://www.asa2012.com/PDFs_abstracts/davidson.pdf
↑ Sikich, N; Lerman, J (2004). "Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale". Anesthesiology. 100 (5): 1138–45. doi:10.1097/00000542-200405000-00015. PMID 15114210.
↑ Mason, LJ (2004). "Pitfalls of Pediatric Anesthesia: Emergence Delirium" (PDF). Richmond, Virginia: Society for Pediatric Anestheisa. Retrieved 2012-06-21.
↑ E. Card, P. Pandharipande, C. Tomes, C. Lee, J. Wood, D. Nelson, A. Graves, A. Shintani, E. W. Ely and C. Hughes (2014) Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit. Br. J. Anaesth. (2014) doi: 10.1093/bja/aeu442 First published online: December 23, 2014

Smessaert A; Schehr CA; Artusio JF, Jr. (April 1960). "Observations in the immediate postanaesthesia period. II. Mode of recovery" (PDF). Br J Anaesth. 32 (4): 181–5. doi:10.1093/bja/32.4.181. PMID 13831798.
Eckenhoff JE, Kneale DH, Dripps RD (Sep–Oct 1961). "The incidence and etiology of postanesthetic excitment. A clinical survey" (PDF). Anesthesiology. 22 (5): 667–73. doi:10.1097/00000542-196109000-00002. PMID 13889092.
Artusio JF, Jr. (April 1964). "Anesthesia and its immediate postoperative complications". Surg Clin North Am. 44: 493–504. PMID 14180336.
Vlajkovic GP, Sindjelic RP (Jan 2007). "Emergence delirium in children: many questions, few answers". Anesth. Analg. 104 (1): 84–91. doi:10.1213/01.ane.0000250914.91881.a8. PMID 17179249.
Lepouse C, Lautner CA, Liu L, Gomis P, Leon A (Jun 2006). "Emergence delirium in adults in the post-anaesthesia care unit". Br.J.Anaesth. 96 (6): 747–53. doi:10.1093/bja/ael094. PMID 16670111.

Anesthesia (outline)

Types	General Sedation Twilight anesthesia Local Topical Intercostal nerve block Neuraxial blockade Spinal Epidural Dental Inferior alveolar nerve

Techniques	Airway management Anesthesia provision in the US Arterial catheter Bronchoscopy Capnography Dogliotti's principle Drug-induced amnesia Intraoperative neurophysiological monitoring Nerve block Penthrox inhaler Tracheal intubation

Scientific Principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect

Measurements	ASA physical status classification system Baricity Bispectral index Direct Fick method Entropy monitoring Fick principle Goldman index Guedel's classification Mallampati score Neuromuscular monitoring Thyromental distance

Instruments	Anaesthetic machine Anesthesia cart Boyle's machine Gas cylinder Laryngeal mask airway Laryngeal tube Medical monitor Odom's indicator Relative analgesia machine Vaporiser Double-lumen endotracheal tube Endobronchial blocker

Complications	Emergence delirium Allergic reactions Anesthesia awareness Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization

Fields of study	Cardiothoracic Geriatric Oral sedation dentistry

Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating Department Practitioners Certified Anesthesia Technician Certified Anesthesia Technologist Anaesthetic technician

History	A.C.E. mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation

Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society

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Emergence delirium

In children

Epidemiology

References

Further reading