title: Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale.
abstract: OBJECTIVE
  This randomized control trial was designed to evaluate the incidence of emergence delirium (ED) in preschool children receiving sevoflurane or desflurane anesthesia combined with an effective caudal block.
  
  
  BACKGROUND
  While ED has been described in children receiving sevoflurane or desflurane anesthesia, a direct comparison between the two agents using a validated ED assessment tool has not been reported previously.
  
  
  METHODS
  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. ED was defined as a Paediatric Anesthesia Emergence Delirium scale (PAED) ≥ 10 points. A delirium-specific score (ED I) was calculated from the first three items of the PAED score (eye contact, purposeful actions, awareness of the surroundings) and a nonspecific score (ED II) from the last two items on the PAED score (restlessness and inconsolability) to test the hypothesis that some items of the PAED scale may better reflect clinical ED than others.
  
  
  RESULTS
  Thirty-one (25%) children in each group demonstrated ED after awakening with ED being of shorter duration in the desflurane group than the sevoflurane group. An ED I score of nine points had a sensitivity of 0.93 and a specificity of 0.94 for ED. An ED II score of five points had a sensitivity of 0.34 and specificity of 0.95 for ED.
  
  
  CONCLUSIONS
  Sevoflurane and desflurane anesthesia were associated with similar incidences of ED in children undergoing sub-umbilical surgery and receiving effective regional anesthesia. High scores on the first three items of the PAED scale were highly correlated with ED. The items restlessness and inconsolability had lower sensitivity for the diagnosis of ED.
authors.affiliation: 1st Service of Anesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy.
authors.forename: Bruno G
authors.initials: BG
authors.lastname: Locatelli
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Ingelmo
authors.forename: Sahillioğlu
authors.initials: S
authors.lastname: Emre
authors.forename: Veronica
authors.initials: V
authors.lastname: Meroni
authors.forename: Carmelo
authors.initials: C
authors.lastname: Minardi
authors.forename: Geoff
authors.initials: G
authors.lastname: Frawley
authors.forename: Alberto
authors.initials: A
authors.lastname: Benigni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Marco
authors.forename: Angelica
authors.initials: A
authors.lastname: Spotti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Busi
authors.forename: Valter
authors.initials: V
authors.lastname: Sonzogni
mesh_terms: D000762:Anesthesia Recovery Period; D000763:Anesthesia, Caudal; D018685:Anesthetics, Inhalation; D002245:Carbon Dioxide / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003693:Delirium / Q000139:chemically induced* / Q000523:psychology; D000077335:Desflurane; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007223:Infant; D007530:Isoflurane / Q000031:analogs & derivatives*; D053208:Kaplan-Meier Estimate; D017214:Laryngeal Masks; D008168:Lung / Q000378:metabolism; D008297:Male; D008738:Methyl Ethers; D009407:Nerve Block; D011229:Preanesthetic Medication; D012044:Regression Analysis; D018401:Sample Size; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane