Emergence Delirium: Assessment, Prevention, and Decision-Making

Agitation or delirium during early emergence from anesthesia was first described in the 1960s [1,2]. Smessaert and colleagues [1] described three types of recovery from anesthesia: (1) patients with a tranquil and uneventful recovery; (2) patients who showed a moderate degree of restlessness; and (3) patients who were markedly delirious and uncooperative, and who required special care and restraint. They also described two main causative factors for postanesthetic delirium. The first was related to the anesthetic (cyclopropane more so than ether or barbiturates) and surgical procedures (peripheral surgery less so than intrathoracic or intra-abdominal surgery), and the second was related to the individual characteristics of the patient (e.g., sex, age, and mental attitude). They finally hypothesized that emergence from surgical anesthesia was primarily influenced by the patient’s personality and that pain was not the essential factor causing delirium [1].