Clinical Analysis of Emergence Delirium and Post-operative Pain after ENT Surgeries under General Anesthesia in Children in a Tertiary Teaching Hospital
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 9
Abstract
Background: Post-operative restlessness in children undergoing ENT surgeries under general anesthesia is very common. The post-operative negative behavior in children may be due to emergence delirium (ED) or due to pain and is difficult to differentiate. The management of both these conditions also differs. Aim of the Study: The aim of the study was to identify clinical variables of ED and pain behavior due to post-operative pain in children undergoing ENT surgeries under general anesthesia. Materials and Methods: A total of 150 consecutive children undergoing ENT surgeries under general anesthesia were included in the present study. The American Society of Anesthesiology (ASA) I and II grade children were included in the study. Induction was done with sevoflurane (2–5%); propofol (2–7 mg kg−1) and fentanyl (1.5–2 mcg kg−1) administered before tracheal intubation. Anesthesia was maintained using sevoflurane (2–3%), fentanyl was used as required, and paracetamol (15 mg kg−1 intravenous [I.V.]) was given intraoperatively. Two anesthetists, who were trained, observed and determined simultaneously and independently each single item of faces, legs, activity, cry, and consolability (FLACC) and pediatric anesthesia ED (PAED) scales every 5 min during the first 20 min after awakening in the operation theater to observation in the post-operative recovery room. Awakening was defined as “spontaneous eyes opening.” FLACC scales are routinely used clinically in the hospital’s participants. Observations and Results: A total of 150 children following ENT surgeries under general anesthesia with the ASA status I and II were observed for ED and post-operative pain. 97 children (64.66%, −95% confidential interval [CI] 61–77) showed ED and/or during the 20 min post-awakening period in the recovery room. There were 95/150 (63.33%) male children and 55/150 (36.66%) female children. The mean age was 8.16 ± 2.55 years. 111/150 (74%) children displayed early post-operative negative behavior (e-PONB) with minimum one episode of ED and/or pain during the first 20 min following awakening. Children were more than twice likely demonstrated e-PONB with sevoflurane than with propofol. ED at awakening was seen in 51/111 at the time of awakening (45.94%, 95% CI 41–49); 42/111 (37.83%, 95% CI - 32–39) after 15 min; and 18/111 (16.21%, 95% CI - 14–18) after 20 min. The prevalence of ED seems to decrease with the passage of time during post-operative recovery of children. Conclusions: The clinical scales PAED and FLACC allowed clear distinction between ED and pain in the early awakening phases after general anesthesia. Children with ED demonstrated “no eye contact” and “no awareness of surroundings.” The association of these two characteristics had a high sensitivity to identify ED during the first 20 min after awakening. The combination of “abnormal facial expression,” “crying,” and “inconsolability” has a high sensitivity and specificity to detect pain in the early post-operative period.
Authors and Affiliations
C H Anil Kumar
Keywords
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