Emergence delirium in children undergoing dental surgery under general anaesthesia

Abstract

Background: Emergence delirium (ED) is a well described complication in paediatric anaesthesia, occurring more often in short surgical procedures using volatile anaesthetics with a rapid recovery profile. Dental surgery is often performed under general anaesthesia in children who would not tolerate dental chair procedures, those with special needs or requiring extensive dentistry. The occurrence of ED in these children at a regional academic hospital was not known. Aim: The purpose of this study was to describe the occurrence of ED and the associated risk factors in children undergoing elective dental surgery at Rahima Moosa Mother and Child Hospital. Methods: A prospective, descriptive study of healthy children aged two to six years undergoing elective dental surgery under general anaesthesia was undertaken. Patients were anaesthetised using standardised research protocols. Assessments included: demographics of the child and caregiver, child anxiety at induction using the modified Yale Preoperative Anxiety Scale, intraoperative events and Paediatric Anaesthesia Emergence Delirium score in the recovery room. Data were assessed for associations and correlations. Results: Ninety-one children with a mean age of 43.4 (SD=10.4) months were included in the study. Anxiety was present in 69.2% at induction and ED was found in 51.6% of the patients. Children with ED required an increased number of interventions in the recovery room (p<0.0001). No association was found with age, gender, education level of the caregiver, number of dental interventions, duration of anaesthesia, intubation status in the recovery room and time to discharge. Correlations between ED and anxiety, age and duration of anaesthesia were not significant. Conclusions: ED occurs commonly after general anaesthesia for dental surgery but no associated risk factors could be identified. The majority of the children presenting for dental surgery are anxious. Children with ED require more interventions in the recovery room but few require pharmacological treatment.