pem pearl: emergence reactions
Emergence reactions after procedural sedation are relatively common in children (2-7%) and can be very distressing, consisting of hallucinations, nightmares and severe agitation. These reactions often require extra pharmacologic interventions which can lead to prolonged sedation/time in ED and even worse, side effects such as respiratory depression.
This study out of China looked at the efficacy of maternal voice orientation in reducing rates of emergence agitation (EA) in children undergoing general anesthesia for tonsillectomy and adenoidectomy. 360 children aged 5-12 were randomized to 3 groups. After surgery, noise-cancelling headphones were placed on the child and played recordings of 1) the mother's voice orienting the child to their surroundings and telling them to wake up, 2) the mother's voice telling them to wake up or 3) white noise.
The orientation group had the lowest level of EA (8%), followed closely by the wake up group (19%), and in a distant third place was the white noise group (35%). This in turn led to less rescue medications given to the first 2 groups, and also led to faster extubation, quicker awakening and shorter PACU stays.
Bottom Line: repeated maternal voice orienting a child to their surroundings can be an effective way to decrease the incidence and severity of emergence agitation in children after sedation. While this study was focused on children undergoing general anesthesia and overall had a much higher incidence of agitation compared to what is reported in procedural sedation literature, it is a safe and easy intervention that I think can be regularly implemented in our procedural sedation practices in the PED.
This study out of China looked at the efficacy of maternal voice orientation in reducing rates of emergence agitation (EA) in children undergoing general anesthesia for tonsillectomy and adenoidectomy. 360 children aged 5-12 were randomized to 3 groups. After surgery, noise-cancelling headphones were placed on the child and played recordings of 1) the mother's voice orienting the child to their surroundings and telling them to wake up, 2) the mother's voice telling them to wake up or 3) white noise.
The orientation group had the lowest level of EA (8%), followed closely by the wake up group (19%), and in a distant third place was the white noise group (35%). This in turn led to less rescue medications given to the first 2 groups, and also led to faster extubation, quicker awakening and shorter PACU stays.
Bottom Line: repeated maternal voice orienting a child to their surroundings can be an effective way to decrease the incidence and severity of emergence agitation in children after sedation. While this study was focused on children undergoing general anesthesia and overall had a much higher incidence of agitation compared to what is reported in procedural sedation literature, it is a safe and easy intervention that I think can be regularly implemented in our procedural sedation practices in the PED.
