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ORIGINAL RESEARCH article

Front. Pediatr.
Sec. Pediatric Surgery
Volume 12 - 2024 | doi: 10.3389/fped.2024.1437460

The Impact of Diurnal variations on Emergence delirium after General Anaesthesia and Surgery in Children

Provisionally accepted
Wei Wei Wei Wei 1Haihang Xie Haihang Xie 1Yingyi Xu Yingyi Xu 1Jingwen Qin Jingwen Qin 1XINYING GUO XINYING GUO 1Xing Rong Song Xing Rong Song 1Gaofeng Yu Gaofeng Yu 1Na Zhang Na Zhang 1Daqing Ma Daqing Ma 2Yonghong Tan Yonghong Tan 1Tianyun Zhao Tianyun Zhao 1*
  • 1 Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
  • 2 Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England, United Kingdom

The final, formatted version of the article will be published soon.

    Background: Emergence delirium (ED) is a widely recognised issue that prolongs mechanical ventilation and Post-Anesthesia Care Unit (PACU) resuscitation time, consequently increasing hospital costs and mortality. Postoperative disturbance in circadian rhythms, commonly leading to sleep disorders, have been identified as a significant risk factor for ED. However, the influence of surgery timing (morning vs. afternoon) on the incidence of ED in pediatric patients undergoing general anesthesia remains unknown. Methods: Patients aged 2-6 years operated under general anaesthesia with a Bispectral Index (BIS) value between 50-60 were categorized based on anesthesia start time into Morning Surgery Group (Group M, 8:00 -12:00) and Afternoon Surgery Group (Group A, 13:00 -17:00). The primary outcome was the incidence of ED assessed by the Cornell Assessment of Pediatric Delirium (CAPD) score post-extubation. Secondary outcomes included extubation time, duration of PACU stay, postoperative adverse events and complications. Results: We recruited 560 children who were randomly assigned to the Group M and the Group A (280/group).Compared to Group M, Group A exhibited a significantly higher incidence of ED (p < 0.001), elevated CAPD scores (p < 0.001), and prolonged PACU stays (p < 0.001). Notably, there was no significant difference in extubation time and anaesthesia-related adverse events or other postoperative complications between the groups. Conclusion: Our study highlights the surgery timing significantly effects the incidence of ED, CAPD scores and PACU stay duration in children. Further validation of these findings may guide future strategies to reduce ED.

    Keywords: emergence delirium, Diurnal variations, circadian rhythms, pediatric, general anaesthesia

    Received: 23 May 2024; Accepted: 25 Sep 2024.

    Copyright: © 2024 Wei, Xie, Xu, Qin, GUO, Song, Yu, Zhang, Ma, Tan and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Tianyun Zhao, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.