Incidence and Risk Factors of Emergence Agitation in Pediatric Patients after General Anesthesia
Ananchanok Saringcarinkul MD*, Sithapan Manchupong MD*, Yodying Punjasawadwong MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : To study the incidence and evaluate factors associated with emergence agitation (EA) in pediatrics
after general anesthesia.
Material and Method: A prospective observational study was conducted in 250 pediatric patients aged 2-9
years, who received general anesthesia for various operative procedures in Maharaj Nakorn Chiang Mai
Hospital between October 2006 and September 2007. The incidence of EA was assessed. Difficult parental-
separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also
recorded. Univariate and multivariate analysis were used to determine the factors associated with EA. A
p-value of less than 0.05 was considered significant.
Results : One hundred and eight children (43.2%) had EA, with an average duration of 9.6 + 6.8 minutes. EA
associated with adverse events occurred in 32 agitated children (29.6%). From univariate analysis, factors
associated with EA were difficult parental-separation behavior, preschool age (2-5 years), and general
anesthesia with sevoflurane. However, difficult parental-separation behavior, and preschool age were the
only factors significantly associated with EA in the multiple logistic regression analysis with OR = 3.021
(95% CI = 1.680, 5.431, p < 0.001) and OR = 1.857(95% CI = 1.075, 3.206, p = 0.026), respectively.
Conclusion : The present study indicated that the incidence of EA was high in PACU. Preschool children and
difficult parental-separation behavior were the predictive factors of agitation on emergence. Therefore, anes-
thesia personnel responsible for pediatric anesthesia should have essential skills and knowledge to effec-
tively care for children before, during, and after an operation, including implementing the methods that
minimize incidence of EA.
Keywords : Emergence agitation, Difficult parental-separation, Children, Pediatric, Sevoflurane
