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Waking Up Is Hard To Do
Better Living Through Chemistry
Toddlers:1 Anesthesia: 0
Exorcist or Anesthesia
The AORN Rulebook
100

This is the typical timeframe in which emergence delirium manifests in a pediatric patient.

What is within the first 10 to 30 minutes of PACU arrival?

100

This rapid-onset inhalation anesthetic is the primary agent linked to high rates of pediatric emergence delerium.

What is Sevoflurane?

100
  • This is the primary physical complication that nurses must rule out first when a child wakes up screaming and thrashing.

What is postoperative acute pain?

100
  • This specific developmental age group carries the highest statistical risk for developing emergence delirium.

What are preschoolers and toddlers (ages 1 to 5 years)?

100
  • AORN guidelines heavily emphasize this non-pharmacological safety intervention as a first-line action to prevent physical injury during an ED episode.

What is keeping the side rails up, padding the crib, and having a clinician at the bedside to prevent falls or IV dislodgement?

200

This behavioral state is the hallmark feature of emergence delirium, making the child completely unresponsive to voice or parental comfort

What is non-purposeful thrashing and inconsolability?

200
  • This highly selective alpha-2 adrenergic agonist is frequently given IV or intranasally to prevent and treat emergence delirium without causing respiratory depression.

What is Dexmedetomidine (Precedex)?

200

This validated objective scoring tool uses five criteria to measure severity of agitation and delirium.

What is the PAED scale?

Pediatric Anesthesia Emergence Delirium

200

This psychological baseline state in a child before entering the operating room strongly predicts postoperative delirium.

What is high preoperative anxiety (or a distressed parental separation)?

200

Per AORN guidelines, this environmental modification should be prioritized in the PACU to reduce sensory overload for an emerging child.

What is dimming the lights and minimizing loud noises/alarms?

300
  • This vital sign trend is commonly seen during an ED episode due to autonomic nervous system hyperactivation.

What is tachycardia and hypertension?

300

Administered in low, sub-hypnotic doses (e.g., 0.5–1 mg/kg), this fast-acting intravenous sedative is an effective rescue medication for severe ED in the PACU.

What is Propofol?

300
  • This specific numeric score on the 5-item PAED scale is the widely accepted cutoff indicating definitive emergence delirium.
  • What is a score of 10 or higher?
300
  • According to perioperative data, surgeries involving these specific anatomical areas have the highest incidence of ED.
  • What are Otolaryngology (ENT) and Ophthalmic (eye) procedures?
300

To foster a family centered environment and assist in orienting the child, AORN recommends this intervention as soon as phase 1 recovery safety criteria allow.

What is bringing the parents or primary caregivers to the bedside?

400

These factors present similarly to emergence delirium.

What are hypoxia, pain, increased ICP, full bladder, and awakening in strange surroundings.

400
  • While excellent for pre-op anxiety, this benzodiazepine can occasionally cause paradoxical agitation or prolong PACU stay, giving it a mixed track record for emergence delirium prevention.

What is Midazolam (Versed)?

400

Unlike a child in pain who will often localize their discomfort or calm down when held by a parent, a child experiencing true emergence delirium will uniquely exhibit this social deficit, meaning pain medications will not solve it.



What is a complete lack of eye contact or awareness of their surroundings and caregivers?

400

This specific child temperament style is a documented independent risk factor for emergence distress.

What is a child who is highly impulsive, emotional, or less adaptable to new environments?

400

 Under AORN guidelines for perioperative care, ensuring this specific medical device or aid is returned to the child immediately upon waking can reduce postoperative delirium and confusion.

What are sensory aids (e.g., eyeglasses or hearing aids)?