Emergence agitation (delirium) in the PACU is characterised by which constellation and which patient group is at HIGHEST risk?
- A Disorientation, moaning, crying, purposeless movements; highest risk in young children after volatile anaesthesia (especially sevoflurane/desflurane) ✓
- B Amnesia and relaxation; highest risk in elderly patients after opioids
- C Sedation, pinpoint pupils, respiratory depression; highest risk after ketamine
- D Muscle rigidity and hyperthermia; highest risk in patients on SSRIs
Explanation
Emergence agitation (EA) or paediatric emergence delirium presents as disorientation, inconsolable crying, moaning, thrashing, and non-purposeful movements that are unrelated to pain. Children aged 2–5 years undergoing volatile anaesthesia — especially with the newer rapid-washout agents sevoflurane and desflurane — have the highest incidence (up to 80% with desflurane). Premedicating with midazolam, using propofol for maintenance, or adding dexmedetomidine significantly reduces EA. Adults can also develop EA but less commonly. The description in option D is serotonin syndrome or malignant hyperthermia, not EA.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.