Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale

<jats:title>Summary</jats:title><jats:sec><jats:title>Objectives/Aim</jats:title><jats:p>This randomized control trial was designed to evaluate the incidence of emergence delirium (<jats:styled-content style="fixed-case">ED</jats:styled-content>) in preschool children receiving sevoflurane or desflurane anesthesia combined with an effective caudal block.</jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p>While <jats:styled-content style="fixed-case">ED</jats:styled-content> has been described in children receiving sevoflurane or desflurane anesthesia, a direct comparison between the two agents using a validated <jats:styled-content style="fixed-case">ED</jats:styled-content> assessment tool has not been reported previously.</jats:p></jats:sec><jats:sec><jats:title>Methods/Materials</jats:title><jats:p>Two hundred and sixty preschool children scheduled for elective sub‐umbilical surgery were randomized to receive sevoflurane or desflurane anesthesia combined with a caudal block. <jats:styled-content style="fixed-case">ED</jats:styled-content> was defined as a Paediatric Anesthesia Emergence Delirium scale (<jats:styled-content style="fixed-case">PAED</jats:styled-content>) ≥10 points. A delirium‐specific score (<jats:styled-content style="fixed-case">ED</jats:styled-content> I) was calculated from the first three items of the <jats:styled-content style="fixed-case">PAED</jats:styled-content> score (eye contact, purposeful actions, awareness of the surroundings) and a nonspecific score (<jats:styled-content style="fixed-case">ED II</jats:styled-content>) from the last two items on the <jats:styled-content style="fixed-case">PAED</jats:styled-content> score (restlessness and inconsolability) to test the hypothesis that some items of the <jats:styled-content style="fixed-case">PAED</jats:styled-content> scale may better reflect clinical <jats:styled-content style="fixed-case">ED</jats:styled-content> than others.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Thirty‐one (25%) children in each group demonstrated <jats:styled-content style="fixed-case">ED</jats:styled-content> after awakening with <jats:styled-content style="fixed-case">ED</jats:styled-content> being of shorter duration in the desflurane group than the sevoflurane group. An <jats:styled-content style="fixed-case">ED</jats:styled-content> I score of nine points had a sensitivity of 0.93 and a specificity of 0.94 for <jats:styled-content style="fixed-case">ED</jats:styled-content>. An <jats:styled-content style="fixed-case">ED II</jats:styled-content> score of five points had a sensitivity of 0.34 and specificity of 0.95 for <jats:styled-content style="fixed-case">ED</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Sevoflurane and desflurane anesthesia were associated with similar incidences of <jats:styled-content style="fixed-case">ED</jats:styled-content> in children undergoing sub‐umbilical surgery and receiving effective regional anesthesia. High scores on the first three items of the <jats:styled-content style="fixed-case">PAED</jats:styled-content> scale were highly correlated with <jats:styled-content style="fixed-case">ED</jats:styled-content>. The items restlessness and inconsolability had lower sensitivity for the diagnosis of <jats:styled-content style="fixed-case">ED</jats:styled-content>.</jats:p></jats:sec>