Risk of Emergence Delirium by Age

Emergence delirium, also known as emergence agitation, is a transient state of confusion and disorientation that occurs as patients emerge from anesthesia or sedation. While emergence delirium can affect individuals of all ages, research suggests that certain age groups may be at higher risk. In this article, we explore the risk of emergence delirium across different age groups and its implications for healthcare providers.

Emergence delirium is relatively common in children undergoing anesthesia for surgery or procedures. Younger children, particularly those between the ages of 2 and 6, are at a higher risk due to their limited ability to understand and communicate their experiences. Factors such as preoperative anxiety, type of surgery, and exposure to certain anesthetic agents can influence the likelihood of emergence delirium in pediatric patients ^1,2.

While emergence delirium is less prevalent in adults compared to children, certain subgroups are at an increased risk. Older adults, especially those over the age of 65, are at greater risk of emergence delirium due to age-related changes in cognitive function and metabolism of anesthetic medications. Additionally, individuals with preexisting cognitive impairment, such as dementia, are at higher risk of experiencing emergence delirium ^3,4.

Healthcare providers play a crucial role in preventing emergence delirium by implementing appropriate preoperative interventions. For pediatric patients, strategies such as preoperative education, parental presence during induction of anesthesia, and administration of preoperative sedatives may help reduce anxiety and minimize the risk of emergence delirium^5,6. In adults, optimizing pain management, minimizing exposure to triggering factors (e.g., noise, bright lights), and selecting appropriate anesthetic agents can help mitigate the risk ⁷.

Prompt recognition and management of emergence delirium are essential for preventing complications and ensuring patient safety; to this end, healthcare providers should be vigilant for signs of agitation, confusion, and disorientation during the recovery period and intervene promptly. Non-pharmacological interventions, such as reorientation techniques, calming reassurance, and environmental modifications, should be prioritized as first-line management strategies, but in cases where pharmacological intervention is necessary, medications with a rapid onset and short duration of action, such as benzodiazepines or alpha-2 agonists, may be considered ^8,9.

Postoperative monitoring and follow-up care are critical for assessing the resolution of emergence delirium and addressing any lingering cognitive or behavioral symptoms. Healthcare providers should communicate with patients and caregivers to ensure continuity of care and provide appropriate support as needed ¹⁰.

Emergence delirium poses a significant challenge for healthcare providers across all age groups undergoing anesthesia or sedation. By understanding the risk factors associated with different age groups and implementing targeted prevention and management strategies, healthcare providers can minimize the incidence and impact of emergence delirium on patient outcomes.

References

1.        Emergence delirium and agitation in children – UpToDate. Available at: https://www.uptodate.com/contents/emergence-delirium-and-agitation-in-children. (Accessed: 9th April 2024)

2.        Liu, K., Liu, C. & Ulualp, S. O. Prevalence of Emergence Delirium in Children Undergoing Tonsillectomy and Adenoidectomy. Anesthesiol. Res. Pract. (2022). doi:10.1155/2022/1465999

3.        Assefa, M. T., Chekol, W. B., Melesse, D. Y., Nigatu, Y. A. & Bizuneh, Y. B. Incidence and risk factors of emergence delirium in elderly patients after general or spinal anesthesia for both elective and emergency surgery. Ann. Med. Surg. (2022). doi:10.1016/j.amsu.2022.104959

4.        Wei, B. et al. Risk factors for emergence agitation in adults after general anesthesia: A systematic review and meta-analysis. Acta Anaesthesiologica Scandinavica (2021). doi:10.1111/aas.13774

5.        Huett, C. et al. Prevention and Therapy of Pediatric Emergence Delirium: A National Survey. Pediatr. Drugs 19, 147–153 (2017). DOI: 10.1007/s40272-017-0212-x

6.        Gonsalvez, G., Baskaran, D. & Upadhyaya, V. Prevention of Emergence Delirium in Children – A Randomized Study Comparing Two Different Timings of Administration of Midazolam. Anesth. Essays Res. 12, 522 (2018). doi: 10.4103/aer.AER_52_18

7.        Swarbrick, C. J. & Partridge, J. S. L. Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia (2022). doi:10.1111/anae.15607

8.        Cerejeira, J. & Mukaetova-Ladinska, E. B. A Clinical Update on Delirium: From Early Recognition to Effective Management. Nurs. Res. Pract. (2011). doi:10.1155/2011/875196

9.        Oliven, R. et al. Early detection and intervention for patients with delirium admitted to the department of internal medicine: Lessons from a pilot initiative. Dement. Geriatr. Cogn. Dis. Extra (2021). doi:10.1159/000515958

10.       Postoperative Delirium – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK534831/. (Accessed: 9th April 2024)