Pediatric Anesthesia: A Guide for the Non-Pediatric Anesthesia Provider Part I

Author(s): Malgorzata Lutwin-Kawalec, Sheaba Varghese and Dinesh K. Choudhry

DOI: 10.2174/9789815036245122010008

Cite As
PACU Management and Emergence Delirium

Pp: 156-181 (26)

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* (Excluding Mailing and Handling)

  • * (Excluding Mailing and Handling)

Abstract

SHS investigation development is considered from the geographical and historical viewpoint. 3 stages are described. Within Stage 1 the work was carried out in the Department of the Institute of Chemical Physics in Chernogolovka where the scientific discovery had been made. At Stage 2 the interest to SHS arose in different cities and towns of the former USSR. Within Stage 3 SHS entered the international scene. Now SHS processes and products are being studied in more than 50 countries.

Abstract

Recovery of children from anesthesia may be complicated by multiple
unique issues encountered in the postanesthesia care unit (PACU). Emergence
delirium is a dissociated state of consciousness, irritability, uncooperativeness, and
inconsolability that may cause injury to the child or staff. Malignant hyperthermia is
a rare genetic state of hypermetabolism that presents with hyperthermia, hypercarbia,
acidosis, rhabdomyolysis, and arrhythmias. Timely treatment with dantrolene is
lifesaving. Common postoperative respiratory events include stridor, laryngospasm,
and bronchospasm. Postextubation stridor is noisy breathing during inspiration
caused by airway mucosal injury or pressure from an endotracheal cuff, treated with
humidified oxygen, racemic epinephrine, and dexamethasone. Laryngospasm, a
partial or complete closure of the glottis, is an emergency that may lead to hypoxic
cardiac arrest and requires timely recognition and treatment with positive pressure
ventilation (PPV), medications, and possibly intubation. Bronchospasm is a clinical
manifestation of exacerbated underlying airway hyperreactivity, treated with inhaled
bronchodilators, intravenous epinephrine, and steroids. Cardiovascular events include
arrhythmias and blood pressure abnormalities. Bradycardia is a common dysrhythmia
in children usually caused by hypoxemia or vagal stimulation, treated with oxygen,
PPV, and intravenous epinephrine,or anticholinergics. Narrow complex
tachycardias—sinus tachycardia and supraventricular tachycardia—may be caused
by pain, hypoxia, emergence agitation, or medications such as epinephrine or
anticholinergics. Their management depends on etiology and consists of vagal
maneuvers, adenosine, or synchronized cardioversion. Known risk factors for
postoperative nausea and vomiting (PONV) in children include surgeries of longer
than 30 minutes, age over 3 years, strabismus surgery, and previous history of PONV.
Our standardized PACU handoff tool is discussed.

Keywords:

Apnea of prematurity, Bradycardia, Bronchospasm, Cardiac arrest, Child Life, Discharge, Emergence delirium, Family-centered care, Guidelines, Handoff, Hypotension, Laryngospasm, Malignant hyperthermia, Narrow complex, Non-triggering anesthetic, Postanesthesia care unit, Postextubation stridor, Postobstructive pulmonary edema, Postoperative nausea and vomiting, Premature atrial contractions, Premature ventricular contractions, Tachycardia.

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