title: [The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica].
abstract: OBJECTIVE
  Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica.
  
  
  METHODS
  This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted.
  
  
  RESULTS
  145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9±7.8min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7±10.8min for non-agitated children; p<0.001). Factors positively associated with emergence delirium included younger age (p=0.01, OR 3.3, 95% CI 1.2-8.6) and moderate and severe anxiety prior to induction (p<0.001, OR 5.6, 95% CI 2.3-13.0). Complications of emergence delirium included intravenous line removal (n=1), and surgical site bleeding (n=3).
  
  
  CONCLUSIONS
  Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.
authors.affiliation: Bustamante Hospital for Children, South East Regional Health Authority, Kingston, Jamaica; Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gooden
authors.affiliation: Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica. Electronic address: ingrid@landscreek.net.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tennant
authors.affiliation: Bustamante Hospital for Children, South East Regional Health Authority, Kingston, Jamaica.
authors.forename: Brian
authors.initials: B
authors.lastname: James
authors.affiliation: Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica.
authors.forename: Richard
authors.initials: R
authors.lastname: Augier
authors.affiliation: Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica.
authors.forename: Annette
authors.initials: A
authors.lastname: Crawford-Sykes
authors.affiliation: Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Ehikhametalor
authors.affiliation: Unidade de Recursos para Pesquisa em Saúde, Dean's Office, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica.
authors.forename: Georgiana
authors.initials: G
authors.lastname: Gordon-Strachan
authors.affiliation: Departamento de Cirurgia, Radiologia, Anestesia e Tratamento Intensivo, University of the West Indies, Kingston, Jamaica.
authors.forename: Hyacinth
authors.initials: H
authors.lastname: Harding-Goldson
keywords: Agitation; Agitação; Anestesia pediátrica; Delírio de emergência; Emergence delirium; Pediatric anesthesia; Sevoflurane; Sevoflurano