Identification of risk factors for emergence delirium in children undergoing magnetic resonance imaging

Purpose: Emergence delirium (ED) remains an ongoing concern for children undergoing sedation/anesthesia. The purpose of this study was to identify risk factors for ED in a population of children from two to seven years of age undergoing sedation/anesthesia for magnetic resonance imaging.

Design and methods: This was a descriptive, observational study taking place in a free-standing midwestern pediatric hospital. The Child Induction Behavioral assessment (CIBA) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were used to assess child/parent anxiety. The presence of ED was documented using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Associations between ED demographic and clinical characteristics were assessed using Chi-square and Wilcoxon Rank Sum tests.

Results: Of the 136 children who underwent sedation/anesthesia for MRI, 23 (16.9 %) experienced ED. Although not significant, children who received the pre-medication midazolam experienced an increased incidence of ED (25.6 %) compared to those who did not (13.4 %, p = 0.09). Children who experienced ED took a significantly shorter time to arouse from sedation/anesthesia (median = 8 min) compared to those who did not experience ED (median = 15 min, p < 0.0001).

Conclusions: A shorter post-procedural arousal time was a significant risk factor associated with ED in this sample of children undergoing MRI.

Implications: It is unclear which pre-procedural factors predict children who will experience ED. There is a need for interdisciplinary research to identify interventions to decrease the incidence of pediatric ED. More research is needed to support the development of interventions to best support the safety of the child experiencing ED.