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: Cold cash just keeps washing in from ALS challenge

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

Cold cash just keeps washing in from ALS challenge

20 hours ago

In the couple of hours it took an official from the ALS Association to return a reporter's call for comment, the group's ubiquitous "ice bucket challenge" had brought in a few million more dollars.

Medtronic spends $350M on another European deal

Aug 27, 2014

U.S. medical device maker Medtronic is building stronger ties to Europe, a couple months after announcing a $42.9 billion acquisition that involves moving its main executive offices across the Atlantic, where it can get a ...

Mind over matter for people with disabilities

Aug 26, 2014

People with serious physical disabilities are unable to do the everyday things that most of us take for granted despite having the will – and the brainpower – to do so. This is changing thanks to European ...

Ukraine's former world's tallest man dies

Aug 25, 2014

Ukraine's tallest man, who briefly held the world record but gave it up to live as a recluse, has died due to complications from the condition that saw him never stop growing, local media reported Monday.

User comments : 0