The incidence of emergence delirium in children with sevoflurane for induction and isoflurane for maintenance of anaesthesia: A prospective observational study

Background: Post-operative emergence delirium (ED) has a varied incidence. Methods: In this prospective observational study carried out in 150 children (2-12 years) posted for elective surgeries under general anaesthesia using sevoflurane for induction and isoflurane for maintenance of anaesthesia we assessed the incidence of ED and attempted to identify risk factors for ED. Postoperatively, ED was assessed with paediatric anaesthesia ED (PAED) score at 15-min interval along with face, leg, activity, cry, consolation (FLACC) score for pain, and risk factors were identified. Results: ED occurred in 42/150 (28.1%) children. Among the children who developed ED, 73.8% were in the age group of 2–6 years, 85% were males, 63% had parental presence and 92.8% received no pre-medication. The mean FLACC score was 0.76 ± 2.02 and patients with ED had FLACC score < 4. The mean duration spent in post-anaesthesia care unit (PACU) was 130 min for children with ED and 96 min in children who did not manifest ED ( P = 0.0003). Conclusions: The judicious use of sevoflurane, age-appropriate pre-medication, distraction techniques and limiting fasting duration helps in avoiding ED. Using the FLACC scoring system with PAED score can help in differentiating pain from ED and treat accordingly. Clinical Trials Registry of India No. CTRI/2020/02/023660.