Pediatric Anesthesia and Emergence Agitation Management
Summary
Pediatric anaesthesia presents unique challenges in achieving a smooth induction, maintenance and recovery in children whose neurodevelopmental status and physiological responses differ markedly from adults. One of the most vexing complications is emergence agitation, a transient state of confusion, inconsolable crying and disoriented behaviour occurring on waking from general anaesthesia, particularly with sevoflurane and desflurane. Risk factors include younger age, preoperative anxiety, rapid emergence and inadequate analgesia. Management strategies span depth-of-anaesthesia monitoring, tailored dosing of inhalational or intravenous agents and adjunctive drugs such as α2-adrenoceptor agonists or ketamine isomers. The goal is to minimise neurobehavioural disturbance without prolonging recovery or compromising cardiovascular stability. Recent advances emphasise multimodal approaches, integrating pharmacological modulation with non-pharmacological measures such as parental presence on induction and specialised distraction techniques. This evolving field seeks to harmonise paediatric neurophysiology with safe and efficient perioperative care, thereby reducing distress for children and their families while optimising throughput in busy surgical units.
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Pediatric Anesthesia and Emergence Agitation Management publication trend
The graph below shows the total number of articles in pediatric anesthesia and emergence agitation management across all publications each year (not limited to Nature Index journals).
Technical terms
Emergence agitation: A transient postoperative behavioural disturbance characterised by inconsolable crying, thrashing and disorientation upon recovery from general anaesthesia.
Pediatric Anesthesia Emergence Delirium (PAED) scale: A validated five-item observational tool that quantifies eye contact, purposeful actions, awareness, restlessness and consolability to assess severity of emergence agitation in children.
Bispectral index (BIS): A processed electroencephalographic parameter, scaled 0–100, used to gauge depth of anaesthesia and guide titration of volatile or intravenous agents.
Dexmedetomidine: A highly selective α2-adrenergic agonist with sedative, anxiolytic and modest analgesic properties, employed to attenuate emergence agitation and smooth recovery in paediatric anaesthesia.
References
- Effect of S-ketamine administered at the end of anesthesia on emergence delirium in preschool children undergoing tonsillectomy and/or adenoidectomy. Frontiers in Pharmacology (2023).
- Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective randomized controlled trial. Anaesthesia Critical Care & Pain Medicine (2023).
- Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale. Anesthesiology (2004).
- Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis. Frontiers in Surgery (2022).
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