Incidence and Risk Factors of Emergence Delirium in Children Undergoing General Anaesthesia With Sevoflurane

Background: Emergence delirium is a transient but potentially hazardous recovery phenomenon in children and is reported particularly often after sevoflurane anaesthesia. This study assessed its incidence, temporal pattern, and perioperative predictors in children undergoing elective procedures under sevoflurane-based general anaesthesia. Materials and Methods: A prospective observational study included 240 children aged 2–10 years with ASA physical status I–II. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale. Anaesthesia was maintained with sevoflurane using a standardized institutional protocol. In the post-anaesthesia care unit, emergence delirium was assessed serially with the Pediatric Anesthesia Emergence Delirium scale; a score ≥10 at any assessment defined delirium. Postoperative pain was assessed with the FLACC scale. Multivariable logistic regression identified independent predictors. Results: Emergence delirium occurred in 72 children (30.0%). It was more frequent in children aged 2–5 years than in those aged 6–10 years (41.4% vs 14.0%, χ²=20.90, p<0.001), in children with marked preoperative anxiety (51.1% vs 17.3%, χ²=30.56, p<0.001), and in those with FLACC scores ≥4 (56.0% vs 18.2%, χ²=35.12, p<0.001). Independent predictors were age 2–5 years, marked preoperative anxiety, postoperative pain, and emergence within 10 minutes. Children with delirium required rescue medication more often and remained longer in the recovery unit. Conclusion: Emergence delirium was common after sevoflurane anaesthesia and clustered in younger, anxious children with painful or rapid recovery. Simple perioperative risk recognition may help direct closer recovery-room observation and preventive strategies.