Anaes · Paediatric anaesthesia
Paediatric emergence delirium and postoperative nausea and vomiting
Also known as Emergence agitation children · PAED score · Paediatric PONV · Dexmedetomidine emergence delirium
Fellowship-level coverage of paediatric emergence delirium versus pain, the PAED score, prevention (dexmedetomidine, propofol, TIVA), PACU management, and paediatric PONV risk, prophylaxis, and rescue with weight-based doses for ANZCA Final and allied exams.
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Red flags
- Do not label all thrashing as delirium — treat pain first if scores suggest pain.
- Sevoflurane and preschool ENT surgery are classic ED risk combinations.
- Codeine has no place after tonsillectomy; use multimodal alternatives.
- Do not repeat the same antiemetic class for rescue if it already failed prophylaxis.
- Discharging with unresolved ED or active vomiting is a safety failure.
Meet the patient
A three-year-old arrives in PACU thrashing after a sevoflurane grommet list — pulling at his IV, inconsolable, eyes staring through you. Mum grips your arm and asks if his brain is damaged. Two questions govern the next five minutes: is the airway and oxygen safe, and is this pain or delirium?[1]
The PAED score and a pain score (FLACC) are your two instruments. Treat the dominant diagnosis, not the screaming. In a preschooler after sevoflurane ENT, the commonest answer is emergence delirium — but the dangerous mimics must be excluded first.[1]
References5ShowHide
- [1]Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology, 2004.PMID 15114210
- [2]Apfel CC et al. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology, 1999.PMID 10485781
- [3]Manning AN et al. Dexmedetomidine dosing to prevent pediatric emergence delirium. AANA Journal, 2020.PMID 32990204
- [4]Davidson AJ et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet, 2016.PMID 26507180
- [5]McCann ME et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet, 2019.PMID 30782342