title: Emergence delirium, pain or both? A challenge for clinicians.
abstract: BACKGROUND
  Children commonly display early postoperative negative behavior (e-PONB) after general anesthesia, which includes emergence delirium (ED), discomfort, temperament, and pain. However, it is often difficult for the caregiver to discriminate between various aspects of e-PONB.
  
  
  OBJECTIVE
  This prospective observational study evaluates the possibility to distinguish between ED and pain in young children using validated pediatric observational scales in the early postoperative phase.
  
  
  METHODS
  Following institutional approval and written consent, children undergoing elective adenoidectomy and/or tonsillectomy were enrolled. Following standardized anesthesia, two trained observers simultaneously evaluated children's behavior with the Paediatric Anaesthesia Emergence Delirium Scale (PAED) and with the Face, Legs, Activity, Cry, Consolability scale (FLACC) at extubation, and at 5, 10, and 15 min.
  
  
  RESULTS
  Of 150 children that completed the study, 32 (21%) had ED, 7 (5%) had pain, and 98 (65%) had simultaneously both ED and pain. The association of 'No eye contact', 'No purposeful action' and 'No awareness of surroundings' (ED1) had a sensitivity of 0.96 and a specificity of 0.80 (PPV 0.97, NPV 0.78) to identify ED. 'Inconsolability' and 'Restlessness' (ED2) had a sensitivity of 0.69 and a specificity of 0.88 (PPV 0.83 and NPV 0.78) to identify pain.
  
  
  CONCLUSIONS
  It is difficult to differentiate between ED and pain using FLACC and PAED scores. 'No eye contact', 'No purposeful action', and 'No awareness of surroundings' significantly correlated with ED. 'Inconsolability' and 'Restlessness' are not reliable enough to identify pain or ED in the first 15 min after awakening.
authors.affiliation: Department of Anaesthesia and Intensive Care, Niguarda Ca' Granda Hospital, Milan-Bicocca University, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Somaini
authors.forename: Emre
authors.initials: E
authors.lastname: Sahillioğlu
authors.forename: Chiara
authors.initials: C
authors.lastname: Marzorati
authors.forename: Federica
authors.initials: F
authors.lastname: Lovisari
authors.forename: Thomas
authors.initials: T
authors.lastname: Engelhardt
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Ingelmo
mesh_terms: D000233:Adenoidectomy; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D003693:Delirium; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000150:complications* / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000150:complications* / Q000175:diagnosis*; D014068:Tonsillectomy
keywords: PACU Emergence Delirium; acute pain; general anesthesia