Incidence and Risk Factors of Emergence Delirium in Children Undergoing Orthopedic Surgery: A Secondary Analysis of Postanesthesia Care Unit Data.

BACKGROUND

Emergence delirium (ED) is a postanesthetic phenomenon more frequently observed in children, typically presenting as altered awareness and behavioral disturbances. While research has primarily focused on the hyperactive subtype of ED, emerging evidence highlights the under-recognized hypoactive subtype. Despite its high occurrence in various pediatric surgeries, ED in orthopedic contexts remains insufficiently studied, particularly regarding subtype characteristics and associated risk factors.

DESIGN

Observational, cross-sectional study involved secondary data analysis.

METHODS

A total of 200 children were included. ED was evaluated on the basis of the Traditional Chinese version of the Cornell Assessment of Pediatric Delirium (CAPD-TC) while patients were in the postanesthesia care unit (PACU). Factors associated with pediatric ED were examined through binary logistic regression analysis.

RESULTS

ED incidence was 48.0% on arrival in the PACU and subsequently decreased over time. Among the ED cases, 80.2% were hyperactive and 17.7% were hypoactive. The duration of hypoactive ED was significantly longer than that of hyperactive ED (median: 21.5 vs 10.1 min, P = 0.003). Postoperative pain (odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.03 to 1.43) and laryngeal mask airway use under general anesthesia (OR = 3.03, 95% CI: 1.47 to 6.26) were significantly associated with CAPD-TC-positive ED symptoms after adjustment for covariates.

CONCLUSIONS

The high incidence of ED on arrival in the PACU underscores the necessity of recognizing factors associated with ED and effectively allocating clinical resources. Hyperactive ED was the most common ED subtype, although the hypoactive subtype was characterized by a longer duration. These findings indicate that clinicians should monitor vital signs as well as consciousness recovery and associated risks.