Distinguishing between Emergence Delirium and Pain in Early Post-Operative Period among Paediatric Patients: A Prospective Observational Study

Emergence delirium (ED) and postoperative pain are common and significant concerns in paediatric anaesthesia.Both conditions can occur early in the postoperative period and are challenging to distinguish due to overlapping clinical presentations.ED is characterized by confusion, agitation, and disorientation after anaesthesia, often leading to distress in the child and anxiety among caregivers.Postoperative pain can similarly present with agitation and crying, making differentiation critical for effective management.This study aimed to prospectively observe paediatric patients to identify distinguishing characteristics between ED and pain, thereby improving postoperative care and reducing misdiagnosis.This prospective observational study included 100 paediatric patients aged 2 to 6 years.All participants were ASA physical status 1 or 2 and underwent elective surgeries requiring general anaesthesia.Postoperative behaviour was assessed using the PAED score for ED and the FLACC scale for pain.Two trained observers, blinded to the study hypothesis, evaluated the children at multiple time points during and after surgery.The primary outcomes were the incidence of ED and pain, and the relationship between sevoflurane exposure time and these outcomes.The majority of patients (89.375%) exhibited normal postoperative behaviour, while 10.5% experienced ED, and 3.75% experienced pain without ED.A smaller subset (3.5%) experienced both ED and pain.Patients with sevoflurane exposure greater than 100 minutes had a significantly higher risk of ED, with a risk ratio of 4.5 compared to those with less exposure.ED was most prevalent at awakening and rapidly decreased, while pain became more prominent later in the recovery period.While most paediatric patients recover from anaesthesia without issues, a notable group remains at risk for ED, especially with longer sevoflurane exposure.