Emergence Delirium (ED): A Case Study

Emergence delirium (ED) was first described in the 1960s by Dr. Eckenhoff as "a dissociated state of consciousness in which the child is inconsolable, irritable, uncooperative, typically thrashing, crying, moaning, or incoherent" (Mohkamkar et al., 2014, para. 1)‌. Several possible causes of ED have been proposed including rapid emergence from short acting volatile anesthetics and the chemical makeup of volatile anesthetics themselves (Reduque & Verghese, 2012).‌ ED impacts 5.3% of all post-anesthetic patients as a whole, with the highest incidence (12-13%) occurring in children.(Vlajkovic, Gordana, Sindjelic, & Radomir, 2007). The incidence of ED in children is volatile gas dependent, occurring in 2% of cases after receiving halothane and …show more content…
This is certainly the case at North Arkansas Regional Medical Center, where children routinely receive oral midazolam 0.5mg/kg in the outpatient holding area 15 to 30 minutes prior to being taken to the operating room for induction of general anesthesia. Midazolam has been shown to reduce parental separation anxiety and to facilitate the induction of general anesthesia but is not effective in reducing the incidence of ED (El Batawi, 2015)‌. Another sedative, dexmedetomidine, is a novel drug that is being added to our anesthesia department's armamentarium this week for trial in our pediatric population. Dexmedetomidine is an alpha-2 adrenergic agonist that is eight times more selective for the alpha-2 receptor than is clonidine. This medication possesses many qualities that make it favorable in the outpatient setting: anxiolysis, analgesia, preservation of respiration, and reduced incidence of ED following general anesthesia (Gertler, Brown, Mitchell, & Silvius, 2001)Click and drag to move‌. This promising drug has an intranasal bioavailability of 65 percent and does not cause discomfort when administered via this route. (Iirola et al., 2011)Click and drag to move‌. Thus, dexmedetomidine can be