Emergence delirium in children: a Brazilian survey

Pediatric emergence delirium is presented as a disturbance of consciousness and attention, with disorientation and perceptual alterations, including hypersensitivity to stimuli and hyperactive motor behaviors. Many studies evaluated risk factors and pharmacological regimens to prevent and treat emergence delirium. There have been two reports on the practice of anesthesiologists concerning diagnosis, prevention, and treatment of emergence delirium. We aimed to know the practice of the Brazilian anesthesiologist regarding the concept, risk factors, diagnosis and forms of prevention and treatment of emergence delirium in children. A REDCap® web-based survey was sent to all anesthesiologists associated with the Brazilian Society of Anesthesiology by SMS and e-mail. Considering a population of 24 thousand anesthesiologists in Brazil, a 95% confidence interval and a 5% margin of error, a sample size of 648 responders was required for this study. We obtained 671 responses. Of respondents, 92,8% consider emergence delirium as a relevant adverse event and 39,6% reported that emergence delirium interferes “too much” in the quality of anesthesia in their institution. High levels of childhood anxiety, using sevoflurane and previous history of emergence delirium were considered as risk factors for 79.6%, 79,2%, and 72.3%, respectively. More than 90% considered untreated postoperative pain as a risk factor too. More than half of respondents said they evaluate their patients regarding emergence delirium, but 95.1% did not routinely use a validated score tool. Sixty-seven percent reported not routinely using pharmacological strategies to prevent emergence delirium. Propofol and clonidine were the most common anesthetic given to prevent emergence delirium (15.7% and 15.4%, respectively). Midazolam, propofol, and dexmedetomidine were the most common medication given for treatment (25.6%, 34.5%, and 10.6%, respectively). These raw data were de-identified using REDCap® functionality. It is presented as an Excel CSV spreadsheet along with a data codebook translated into English and the original in Portuguese.

儿科苏醒期谵妄（Pediatric emergence delirium）以意识与注意力障碍为核心表现，伴随定向障碍与感知改变，包括刺激超敏及运动行为亢进。诸多研究已针对苏醒期谵妄的预防与治疗相关危险因素及药物方案展开评估。目前已有两项关于麻醉医师针对苏醒期谵妄的诊断、预防及治疗实践的报道。本研究旨在了解巴西麻醉医师对于儿童苏醒期谵妄的概念、危险因素、诊断方式以及预防与治疗手段的临床实践现状。
本研究通过短信（SMS）与电子邮件的方式，向所有隶属于巴西麻醉医师协会（Brazilian Society of Anesthesiology）的麻醉医师发送了基于REDCap®平台的网络问卷调查。考虑到巴西共有2.4万名麻醉医师，本次研究设定95%置信区间与5%误差边际，所需有效样本量为648份。本研究最终回收有效问卷671份。
在所有受访者中，92.8%的医师认为苏醒期谵妄属于值得关注的不良事件；39.6%的受访者表示，在其所在机构中，苏醒期谵妄“极大程度”影响了麻醉质量。分别有79.6%、79.2%与72.3%的医师认为，儿童高焦虑状态、使用七氟烷以及既往苏醒期谵妄病史为苏醒期谵妄的危险因素。超过90%的受访者将未得到妥善处理的术后疼痛也列为危险因素。超过半数的受访者表示会对患者进行苏醒期谵妄相关评估，但其中95.1%的医师并未常规使用经过验证的评分工具。67%的受访者表示未常规采用药物干预策略以预防苏醒期谵妄。丙泊酚（Propofol）与可乐定（clonidine）是最常用于预防苏醒期谵妄的药物（占比分别为15.7%与15.4%）。咪达唑仑（Midazolam）、丙泊酚与右美托咪定（dexmedetomidine）则是最常用于苏醒期谵妄治疗的药物（占比分别为25.6%、34.5%与10.6%）。
本研究通过REDCap®平台的内置功能对原始数据进行去标识化处理，最终以Excel格式CSV表格的形式公开，同时附带英译版数据编码手册与原版葡萄牙语数据编码手册。