Prevalence of emergence delirium in children schedule for tonsillectomy and adenoidectomy

Abstract

Background: Emergence delirium (ED) is an altered state of consciousness and cognition that often occurs in children after tonsillectomy and adenoidectomy (T&A). Little has been reported about the prevalence of emergence delirium in our population, therefore, this study was designed to find out prevalence of ED amongst children scheduled for tonsillectomy and adenoidectomy.

Material & Methods: A cross-sectional study was conducted from August 23, 2023 to April 28, 2024. The study included children of different ages who were undergoing elective tonsillectomy and adenoidectomy (T&A). Standardised evaluation tools were used to assess the incidence of ED (Paediatric Anaesthesia Emergence Delirium (PAED) scale). Descriptive statistics were used to express the prevalence of Emergence delirium and logistic regression analysis was used to identify potential risk factors associated with Emergence delirium.

Results: Among 246 children who were treated for tonsillectomy and adenoidectomy (T&A), 74 (30.1%) had emergence delirium (ED). Prevalence ranged, being highest in toddlers (18.9%) and lowest in teenagers (21.7%). There was a higher prevalence of ED in males than females (31.9% vs. 27.8%) and a lower weight (<15 kg) was linked to a higher prevalence of ED (38.9%). The highest prevalence of Emergence delirium was seen in patients with sleep apnoea (41.7%). The ED rates in general anaesthesia were higher (33.3%) than local anaesthetics (14.3%). The highest incidence was seen in ASA III (50.0%). Demographic and clinical variables had different perioperative characteristics including PAED ratings and anaesthetic time, pointing to the need for tailored anaesthetic interventions as well as other interventions before, during, and after surgery to decrease the risk of admission to the ED.

Conclusion: Around 30% of the included children with T&A had ED in our institution. Overall anaesthetic duration was significantly longer in the male patient with Emergence delirium, while ASA I patients had a significantly longer phase I duration in the post-anaesthesia care unit (PACU).