Volume 77, July–August 2024, Pages 74-80Author links open overlay panel, , , , , Highlights•

To study predictors of emergence delirium of children undergoing general anesthesia.

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A total of 16 observational studies involving 9,598 children were analyzed.

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The global prevalence of emergence delirium was 19.2%, with risk factors associated with head-neck surgery and younger-age children.

AbstractProblem

Emergence delirium (ED) in children post-general anesthesia has been persistently underestimated, impacting the well-being of children, nurses, and even parents. This study employs integrated analysis to establish a comprehensive understanding of ED, including its occurrence and related risk factors, emphasizing the imperative for enhanced awareness and comprehension among pediatric nursing care providers.

Eligibility criteria

A systematic review and meta-analysis were conducted using four electronic databases, namely PubMed, CINAHL via EBSCOhost, Embase via Elsevier, and ProQuest Dissertations and Theses.

Results

This meta-analysis included 16 studies involving 9598 children who underwent general anesthesia. The pooled prevalence of ED was 19.2% (95% confidence interval [CI] = 0.12 to 0.29), with younger patients exhibiting a higher prevalence of ED. ED research is scant in Africa and is mostly limited to the Asia Pacific region and Northern Europe. Neck and head surgery (odds ratio [OR] = 2.34, 95% CI = 1.29 to 4.27) were significantly associated with ED risk.

Conclusions

ED should be monitored in children who receive general anesthesia. In this study, ED had a prevalence rate of 19.2%, and head and neck surgery were significantly associated with ED risk. Therefore, healthcare professionals should carefully manage and prevent ED in children undergoing general anesthesia.

Implications

A comprehensive understanding of ED's prevalence and risk factors is crucial for enhancing nursing care. Adopting a family-centered care approach can empower parents with information to collaboratively care for their children, promoting a holistic approach to pediatric healthcare.

Section snippetsBackground

Emergence delirium (ED) is an acute onset neuropsychiatric syndrome characterized by cognitive function disturbance, involuntary physical activity, restlessness, delusions, hallucinations, and thrashing in pediatric patients (Dahmani et al., 2014). The occurrence of pediatric ED can lead to self-injury, removal of intravenous catheters, increased stress on caregivers and clinical nurses, and delayed discharge in post-anesthesia care units (PACUs) (Kanaya, 2016; Kuratani & Oi, 2008; Moore &

Materials and methods

This systematic review and meta-analysis were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (Moher et al., 2010). The protocol was prospectively registered on the International Prospective Register of Systematic Reviews on April 4, 2023 (Registration number CRD42023416863).

Selection, inclusion, and study characteristics

We identified 4290 potential studies in the initial search as presented in Fig. 1. After duplicates were deleted and the titles and abstracts of the studies were screened, 23 studies were included in a full-text review. Eight studies were omitted from our analysis, and the rationale for their exclusion can be found in Supplementary Material 2. Additionally, one study was incorporated after conducting a search through the reference lists of the included studies. In total, 16 studies met the

Discussion

ED is an underestimated health problem among children who undergo general anesthesia. In our systemic review and meta-analysis, we explored the global prevalence and risk factors of ED in children following general anesthesia. The pooled prevalence of ED was 19.2% (1% to 49%) in our study and 34% (17% to 66%) in critically ill children in pediatric intensive care units (Semple et al., 2022), indicating that the prevalence of delirium in PACUs may be lower than that in pediatric intensive care

Conclusion

Our results indicate that ED is prevalent in children undergoing general anesthesia, with our findings revealing a global prevalence rate of 19.2%. In addition, head and neck surgery was associated with a higher risk of ED, and a younger age was correlated with a greater ED risk. Our findings can substantially enhance the understanding of the prevalence and factors of ED in children undergoing general anesthesia and enable healthcare providers to provide effective interventions to prevent ED

CRediT authorship contribution statement

Yi-Chen Chen: Writing – review & editing, Writing – original draft, Software, Project administration, Methodology, Formal analysis, Data curation, Conceptualization. Jann Foster: Supervision. Man-Ling Wang: Supervision. Iftitakhur Rohmah: Formal analysis, Data curation. Yu-Hsin Tseng: Software. Hsiao-Yean Chiu: Writing – review & editing, Visualization, Supervision, Project administration, Methodology.

Declaration of competing interest

There are no potential competing interests including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and other funding.

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