Tempête en SSPI : mise au point sur le délire post-anesthésique chez l’enfant
Résumé
Emergence delirium is a common cause of agitation in children in the postanaesthesia care unit (PACU) and may be traumatic for children and parents. The preoperative anxiety and intraoperative use of sevoflurane are risk factors for emergence delirium in preschool children. The prevention of anxiety of children and parents must be initiated during the preoperative consultation (reassurance, explanation of the process) and continued until anaesthetic induction (distraction measures). Prevention of delirium can also be considered using clonidine (premedication or intraoperative) and propofol (intraoperative). In the PACU, priority should be given to finding a treatable cause of agitation (airway obstruction, urinary retention. . .) and optimising analgesia before considering emergence delirium. A specific diagnostic instrument such as the Paediatric Anaesthesia Emergence Delirium scale is useful to confirm the diagnosis. Agitated child with delirium should be kept safe and his (her) parents need reassurance. Data on whether and how emergence delirium should be treated are lacking. Low-dose propofol (1 mg/kg IV) would however be frequently used to shorten an episode of emergence delirium.
Domaines
Médecine humaine et pathologieOrigine | Fichiers produits par l'(les) auteur(s) |
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