Emergence Delirium

A form of DELIRIUM which occurs after GENERAL ANESTHESIA.

Also Known As:

Agitated Emergence; Anesthesia Emergence Delirium; Emergence Agitation; Emergence Excitement; Postanesthetic Excitement; Agitation, Emergence; Agitations, Emergence; Delirium, Anesthesia Emergence; Delirium, Emergence; Delirium, Post-Operative; Delirium, Postoperative; Emergence Delirium, Anesthesia; Emergence, Agitated; Excitement, Emergence; Excitement, Postanesthetic; Post Operative Delirium; Post-Operative Delirium; Postoperative Delirium

Networked: 2283 relevant articles (156 outcomes, 530 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Delirium
2.	Postoperative Pain
3.	Postoperative Nausea and Vomiting (PONV)
4.	Emergence Delirium
5.	Pain (Aches)

Experts

1.	Marcantonio, Edward R: 28 articles (07/2022 - 03/2005)
2.	Inouye, Sharon K: 20 articles (01/2022 - 09/2014)
3.	Wang, Dong-Xin: 15 articles (01/2022 - 01/2010)
4.	Spies, Claudia D: 14 articles (03/2022 - 02/2008)
5.	Avidan, Michael S: 14 articles (12/2020 - 11/2009)
6.	Xie, Zhongcong: 13 articles (07/2022 - 05/2014)
7.	Leung, Jacqueline M: 13 articles (01/2022 - 04/2006)
8.	Xue, Fu-Shan: 12 articles (03/2022 - 01/2019)
9.	Jones, Richard N: 12 articles (01/2021 - 06/2015)
10.	Sieber, Frederick E: 11 articles (12/2021 - 06/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Emergence Delirium:

1.	Dexmedetomidine FDA Link 01/01/2020 - "The 2 meta-analyses found that all included studies had a statistically significant reduction in postoperative delirium when using dexmedetomidine. " 01/01/2019 - "Pre-operative administration of dexmedetomidine demonstrated several significant benefits, such as a lower incidence of emergence agitation, reduced agitation severity, and a shorter duration of agitation. " 12/01/2019 - "We performed this updated meta-analysis to ascertain more precisely the efficacy of dexmedetomidine (DEX) on the incidence of postoperative delirium (POD) in elderly patients after non-cardiac surgery. " 01/01/2019 - "The purpose of this trial was to evaluate whether pre-operative administration of dexmedetomidine is effective in reducing the incidence and severity of emergence agitation in adults undergoing closed reduction of nasal bone fractures. " 01/01/2023 - "Automated phenotyping of postoperative delirium-like behaviour in mice reveals the therapeutic efficacy of dexmedetomidine."
2.	Sevoflurane (Ultane)FDA LinkGeneric 10/01/2020 - "The comparative efficacy of ancillary drugs on sevoflurane-related emergence agitation (EA) in paediatric anaesthesia for adenotonsillectomy remains unclear. " 10/01/2020 - "Comparative efficacy of ancillary drugs in sevoflurane-related emergence agitation after paediatric adenotonsillectomy: A Bayesian network meta-analysis." 01/01/2019 - "The comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial. " 08/01/2018 - "The aim of the study was to investigate the effects of visual preconditioning (application of an eyepatch over the eye to be operated for ≥3 h the day before surgery) on emergence delirium after ophthalmic surgery under sevoflurane anaesthesia. " 04/01/2011 - "Several studies have reported that sevoflurane was associated with a relatively high incidence of emergence agitation in children even in the absence of any surgical intervention. "
3.	Propofol (Diprivan)FDA LinkGeneric 01/01/2022 - "Conclusion: Visual pretreatment is effective in preventing postoperative emergence delirium in children undergoing ophthalmic surgery without significant adverse effects and can also decrease the incidence of propofol rescue." 11/01/2015 - "The efficacy of propofol on emergence agitation--a meta-analysis of randomized controlled trials." 02/22/2019 - "The addition of propofol during the emergence phase of volatile-based general anaesthesia is known to reduce emergence delirium in children; however, the efficacy of this strategy in older patients is not known. " 08/01/2023 - "Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational study." 01/01/2023 - "Clinicians might therefore reasonably select propofol-based anaesthesia in patients at high risk of postoperative delirium. "
4.	Midazolam (Versed)FDA LinkGeneric 09/01/2002 - "Midazolam initially decreased the incidence of emergence agitation but, in the postanaesthesia care unit, significant agitation was seen in all three groups. " 04/01/2018 - "Prevention of Emergence Delirium in Children - A Randomized Study Comparing Two Different Timings of Administration of Midazolam." 01/01/2024 - "Our results suggest that low doses of midazolam can be safely used to pre-medicate elective surgical patients 70 years or older before non-cardiac surgery, without significant effect on the risk of developing postoperative delirium." 12/01/2023 - "Intraoperative administration of midazolam may not induce postoperative delirium in patients undergoing cardiac surgery." 12/01/2023 - "To evaluate the association between the intraoperative administration of midazolam and the incidence of postoperative delirium in patients undergoing cardiac surgery. "
5.	Fentanyl (Sublimaze)FDA LinkGeneric 12/01/2020 - "Emergence delirium was well-controlled, similar to that with fentanyl administration at the end of surgery. " 09/01/2017 - "Fentanyl around the end of surgery significantly decreased emergence agitation incidence (emergence agitation: relative risk 0.43, 95% confidence interval 0.35 to 0.53, I2 =0.0%; severe emergence agitation: relative risk 0.50, 95% confidence interval 0.31 to 0.81, I2 =0.0%). " 09/01/2017 - "The use of fentanyl around the end of surgery has been proposed to prevent emergence agitation. " 09/01/2017 - "Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta-analysis." 04/01/2016 - "To distinguish transient irritability from severe EA, the primary outcome was first-stage postanesthesia care unit (PACU I) peak Pediatric Assessment of Emergence Delirium (PAED) score, with secondary outcomes of PAED and Face, Legs, Activity, Cry, and Consolability scores at emergence, postoperative fentanyl dose, emergence time, and discharge time. "
6.	MelatoninIBA 03/01/2006 - "Unfortunately, there is currently insufficient evidence that exogenous melatonin is effective in preventing or treating postoperative delirium. " 10/30/2023 - "The MELA-PAED trial investigates the efficacy of intravenous intraoperative melatonin for the prevention of emergence agitation in pediatric surgical patients. " 10/30/2023 - "Therefore, the MELA-PAED trial aims to investigate the efficacy and safety of intraoperative intravenous melatonin for the prevention of emergence agitation in pediatric surgical patients. " 01/01/2022 - "This study was designed to consider the effectiveness of melatonin in prevention and treatment of postoperative delirium. " 01/01/2022 - "Studies on melatonin and melatonergic agents (MMA) for the prevention of postoperative delirium (POD) have produced inconsistent findings. "
7.	Ketamine FDA LinkGeneric 11/01/2023 - "Systematic review and meta-analysis including all randomized controlled trials investigating the effects of perioperative ketamine administration in adult patients compared to placebo or no intervention on postoperative delirium and/or POND between January 2007 and April 2022. " 01/01/2023 - "This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. " 10/21/2022 - "Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. " 10/01/2022 - "In this study, we investigated the association of ketamine with postoperative delirium and specific encephalographic signatures. " 12/01/2019 - "In this meta-analysis of 13 randomized controlled trials, high degree of heterogeneity and low certainty of evidence limit the recommendations of ketamine for the prevention of emergence agitation in children undergoing surgery or imaging procedures. "
8.	ramelteon (Rozerem)FDA Link 12/01/2022 - "Preventive effects of preoperative ramelteon on postoperative delirium in Asian elderly population: A randomized, double-blind, placebo-controlled trial, and a systematic review and meta-analysis." 12/01/2023 - "The stratified log-rank test showed no significant difference in preventing postoperative delirium between ramelteon and placebo (χ2 = 0.30, degrees of freedom = 1, p = 0.60). " 01/01/2021 - "In older patients undergoing elective primary or revision hip or knee replacement, ramelteon was not efficacious in preventing postoperative delirium." 01/01/2021 - "The adjusted odds ratio for postoperative delirium as a function of assignment to the ramelteon treatment arm was 1.28 (95% confidence interval: 0.21-7.93; z-value 0.27; p-value = 0.79). " 01/01/2021 - "Response to Comment: "Assessing Preventative Effect of Ramelteon on Postoperative Delirium in Older Patients: Methodology is Important"."
9.	Antipsychotic Agents (Antipsychotics)IBA 04/20/2018 - "Are antipsychotics effective for the prevention of postoperative delirium?" 04/01/2015 - "We included randomized controlled trials of adults undergoing surgery who were given antipsychotics to prevent postoperative delirium. " 03/01/2013 - "Although few studies have examined prophylactic use of antipsychotics, this analysis suggests that perioperative use of prophylactic antipsychotics may effectively reduce the overall risk of postoperative delirium in elderly patients." 09/01/2012 - "Studies investigating the effectiveness of various antipsychotics in the treatment of postoperative delirium have demonstrated somewhat mixed outcomes. " 09/07/2023 - "Professional society guidelines recommend limiting the use of antipsychotics in older patients with postoperative delirium. "
10.	Haloperidol (Haldol)FDA LinkGeneric 03/01/2012 - "For elderly patients admitted to intensive care unit after noncardiac surgery, short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of postoperative delirium. " 07/01/2017 - "The aim of this study was to evaluate the safety and efficacy of the early administration haloperidol in preventing the aggravation of postoperative delirium in elderly patients. " 12/01/2018 - "To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery. " 07/01/2017 - "Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial." 12/01/2014 - "Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial."

Therapies and Procedures

1.	Anesthesia 11/06/2023 - "Postoperative delirium (POD) is an important complication for older patients and recent randomised controlled trials have showed a conflicting result of the effect of deep and light anesthesia. " 12/01/2022 - "Comparison of total intravenous with inhalational anesthesia in terms of postoperative delirium and complications in older patients: a nationwide population-based study." 03/15/2022 - "This trial aimed to investigate the impact of M-Entropy (GE Healthcare, Helsinki, Finland) guidance on emergence from anesthesia and postoperative delirium in thoracic surgery. " 01/01/2021 - "The aim of this study was to determine if exposure to monochromatic blue light (MBL) in the immediate phase of recovery could reduce the overall incidence of emergence delirium in children following general inhalational anesthesia. " 01/01/2021 - "This study investigated the impact of processed electroencephalogram (EEG)-guided anesthesia management on the incidence of postoperative delirium in patients undergoing CEA. "
2.	Analgesia 01/01/2023 - "Its administration has demonstrated numerous positive effects, including anti-anxiety properties, sedation, analgesia, improved postoperative sleep, and the potential to reduce the incidence of postoperative delirium. " 01/01/2023 - "Despite a higher incidence of post-operative delirium, increased time to oral analgesia and greater 30-day readmission rates in the depression cohort, multivariate analyses showed depression was not a significant independent predictor of these (OR 2.181, 95%CI 0.310-15.344; p = 0.433, OR 0.07, 95%CI 0.499-1.408; p = 0.348 and OR 1.367, 95%CI 0.102-18.34, respectively). " 05/01/2022 - "Successful Management of a Patient With a History of Postoperative Delirium Undergoing Cardiac Surgery With an Erector Spinae Plane Block and Multimodal Analgesia: A Case Report." 01/01/2022 - "Adequate preoperative optimization and postoperative analgesia may reduce the prevalence of emergence delirium." 01/01/2022 - "Thoracic paravertebral block analgesia is associated with lower incidence of postoperative delirium, probably due to its anti-neuroinflammatory effects. "
3.	General Anesthesia 05/26/2023 - "In the present study, we investigated the hypothesis that the depth of general anesthesia affects emergence agitation (EA) in children in the early postanesthetic period. " 01/01/2022 - "Li T, Li J, Yuan L, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial. " 01/01/2022 - "This study aimed to determine whether breathing training after watching an informative video during the pre-operative visit could reduce the incidence of emergence delirium in preschool children after otorhinolaryngologic surgery under general anesthesia. " 01/01/2022 - "Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial." 11/12/2021 - "This study will evaluate the effect of the ORNI on the recovery period of general anesthesia by calculating the incidence of emergence agitation, and grading the self-rating anxiety scale and self-rating depression scale scores. "
4.	Premedication 05/01/2006 - "In addition, alpha2-adrenoceptor agonists used as premedication have been shown to substantially reduce anaesthetic requirements among surgical patients, and the use of these agents has been associated with a reduced risk of postoperative delirium, which may be expected to improve considerably the postoperative course for at-risk patients. " 05/01/2015 - "The aim of this survey performed between February and April 2014 was to collect data from the daily clinical practice by experienced pediatric anesthesiologists regarding documentation, premedication, anesthesia regimen and postoperative treatment with respect to children with emergence agitation. " 08/01/2008 - "Subgroup analysis was used to clarify the effects of age, surgical procedure, pain treatment, and premedication on the incidence of emergence agitation. " 12/01/2015 - "Compared with placebo, melatonin premedication may be effective in preventing emergence agitation in children (GRADE: low). " 12/01/2015 - "A conventional random-effects meta-analysis showed that compared with placebo, melatonin premedication may be effective in emergence agitation prevention [risk ratio 0.31, 95% confidence interval (CI) 0.16 to 0.60; I2 = 0%]. "
5.	Length of Stay 10/01/2023 - "Compared with Group Control, video visit helped to increase the first-attempt pass rate of the knowledge retention exam and solve the patient's most worried concerns, and decrease incidence of emergence agitation, total cost of hospitalization and length of hospital stay. " 03/18/2013 - "We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay. " 01/01/2004 - "Despite improved outcomes after cardiac operations, postoperative delirium remains a common complication that is associated with increased morbidity and prolonged hospital stay. " 12/01/2023 - "Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay. " 05/10/2023 - "Although these findings do not establish causality, studies are warranted to determine whether interventions to reduce postoperative blood-brain barrier dysfunction would reduce postoperative delirium rates and hospital length of stay."