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Literature Reviews

Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia
Cole JW, Murray DJ, McAllister JD, Hirshberg GE. Paediatric Anaesthesia 2002 12:442-447.

This interesting article discusses the authors' experience in a prospective trial documenting the incidence and covariables associated with emergence agitation and excitement. Using a qualitative self designed scoring system and a blinded observer (blinded to anesthetic management and premedication) serial scores were obtained every ten minutes in the PACU. A 10% incidence of severe restlessness was noted at emergence and an additional 30% of children were found to be experiencing s significant period of distress during their recovery room stay.

The authors made a significant attempt to provide analgesia before emergence with caudal anesthesia in approximately 70% of the children and midazolam premedication was used in just over half of the children. Midazolam premedication was not randomized and was not controlled in the trial. Anesthetic vapor included halothane for induction and either halothane or isoflurane for maintenance. The incidence noted is similar to previous reports, but what was novel was the description of `delayed' emergence phenomena in 10% of children not noted until after 30 minutes in the PACU. Whether this reflects a slowness to awaken from halothane is not known. Although midazolam administration was statistically associated with an increased incidence of emergence issues in the older children, the authors carefully state that a cause and effect relationship is not shown. They appropriately report the finding and discuss the observation as appropriate for another trial to examine the question directly. I would really like to know the mechanism(s) responsible for this commonly noted problem and an effective prophylactic or therapeutic strategy!

Reviewed by Joseph Tobin, MD #include ./footer_include.iphtml