Pediatric Anesthesia Emergence Delirium Scale Quality Improvement Project and Retrospective Chart Review

Pediatric anesthesia emergence delirium (PAED) is a prevalent postoperative occurrence in a complex patient population. Presentation can manifest in school-aged children as disorientation, confusion, agitation, hallucinations, hypersensitivity, irritability, inconsolability, hyperactive physical behavior, emotional lability, and inconsolable crying. The unpredictability and variable presentation require prompt recognition by staff. The PAED scale developed by Sikich, N. & Lerman (2004) is the most reliable in diagnosing pediatric emergence delirium (PED). Implementation is underutilized postoperatively. Application of the PAED scale in the perioperative setting is not considered standard of care; however, given the potentially harmful outcomes to patients, staff, and family members, utilization may be instrumental in postoperative management. Preventative measures and techniques continue to evolve in research; some have been successful but inconclusive. The aim of this project was a quality improvement pilot study to assess the probable rate of PED, provide recommendations on whether to implement an appropriate assessment scale and provide up-to-date anesthesia perioperative guidelines for PED. A retrospective chart review examined the probable rate of PAED over the last year. Further analysis and evaluation of the anesthetic techniques and potential triggers were assessed. Recommendations for scale implementation and preventative measures for anesthesia were constructed.