Children's agitation after surgery may be preventable

Oct 08, 2010
Temporary combativeness after surgery -- a complication affecting up to half of anesthetized children -- may be preventable with drugs that decrease epinephrine production, according to Dr. Ivan Florentino, a Medical College of Georgia pediatric anesthesiologist. Credit: Phil Jones, Campus Photographer

Temporary combativeness after surgery—a complication affecting up to half of anesthetized children—may be preventable with drugs that decrease epinephrine production, according to a Medical College of Georgia pediatric anesthesiologist.

"Some children wake up after and begin crying and become combative," said Dr. Ivan Florentino, associate professor of anesthesiology and perioperative medicine and pediatrics at MCG. "They are often extremely frightened, disoriented and refuse to be comforted, even after being reunited with their parents. Some even hallucinate and become so agitated that they have to be restrained."

Those reactions, called emergence delirium, may result from a brain dysfunction that increases the release of hormones that prompt "fight-or-flight," a sympathetic nervous system reaction. The findings are being presented at the 50th Honduran National Congress of Anesthesiology Oct. 8-9.

Preschool-aged children and those with behavioral problems and developmental delays are more prone to emergence delirium because their sympathetic nervous system is often already hyperactive, Florentino said. "Some types of anesthesia increase the release of the stress hormone norepinephrine in the brain," he said.

Animal studies suggest traditional inhaled anesthetics are the most common culprits for emergence delirium. Newer drugs, such as those that bind to cells that release epinephrine, can reduce the incidence when given before or with anesthesia.

The disorder can create a challenge for parents and post-anesthesia care providers. Children can become so agitated that they pull out IVs and surgical drains, which can lead to complications such as increased bleeding at the surgical site, he said.

"Preventing this as much as possible is a way to improve children's experience with the operating room and anesthesia," Florentino said. "People used to be simply concerned about whether the patient woke up from surgery. Now the practice has shifted to focus on a better experience for the patients and their families."

Explore further: Were clinical trial practices in East Germany questionable?

Provided by Medical College of Georgia

4 /5 (1 vote)
add to favorites email to friend print save as pdf

Related Stories

Hormone treatment eases post-surgery distress in children

Jul 01, 2009

A scary unknown for many children, the prospect of surgery can cause intense preoperative anxiety. While some amount of stress is normal, what many parents do not know is that extreme anxiety before surgery can contribute ...

Acupressure calms children before surgery

Oct 01, 2008

An acupressure treatment applied to children undergoing anesthesia noticeably lowers their anxiety levels and makes the stress of surgery more calming for them and their families, UC Irvine anesthesiologists have learned.

Recommended for you

Were clinical trial practices in East Germany questionable?

Oct 23, 2014

Clinical trials carried out in the former East Germany in the second half of the 20th century were not always with the full knowledge or understanding of participants with some questionable practices taking place, according ...

Schumacher's doctor sees progress after injury

Oct 23, 2014

A French physician who treated Michael Schumacher for nearly six months after the Formula One champion struck his head in a ski accident says he is no longer in a coma and predicted a possible recovery within three years.

User comments : 0