Emergence delirium

 

Risk factors:

Patient

·          Pre-school age

·          Anxiety

Anaesthesia

·          Negative interactions

·          Induction distress

·          Halogenated ethers

Surgery

·          Pain

·          Eyes

·          ENT

 

Protective factors:

Pre-op

Weeks before:

·          Hospital tour

·          Educational material for parent

·          Parental discussion with child

Pre-med:

·          α2 agonist

·          Ketamine

·          ±Midazolam (only reduces induction distress)

Intra-op

Induction:

·          Parent present

·          YouTube video

Maintenance:

·          Propofol

·          Analgesia (incl. regional)

·          α2 agonist

·          Ketamine

·          Magnesium

Post-op

·          Analgesia

·          Quiet

·          Parent present

Rescue disaster

·          Analgesia

·          Clonidine

·          Ctrl+Alt+Del = Propofol GA

 

Grading:

PAED

Score 0-4 for each of:

·          Eye contact

·          Purposeful motor output

·          Awareness of surroundings

·          Restlessness

·          Inconsolability

Cravero

1.        Unresponsive

2.        Responsive

3.        Conscious

4.        Crying

5.        Needs restraint

Watcha

0.        Asleep

1.        Calm

2.        Crying but consolable

3.        Crying inconsolably

4.        Agitated, thrashing

FLACC

For pain

·          Face

·          Legs

·          Activity

·          Crying

·          Consolability

 

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