Hysterical kid post extubation

[soorg]

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Do a decent amount of peds, both IP and OP. Most are ok, but every now and then one wakes up hysterically crying. Any pointers on how to resolve this? I give 'em enough fentanyl intraop so that they're pretty narcotized, but still happens every now and then...

 

[ssmallz]

couple of mg of propofol will mellow them out. Take em to the pacu and let em reemerge out there

 

[Fastrach]

couple of mg of propofol will mellow them out. Take em to the pacu and let em reemerge out there

Agreed. Propofol at end of the case, extubate them deep (if reasonable), and let them emerge in PACU with parents. 👍

 

[sevo85288]

mepridine after emergence. works like a charm.

 

[Trisomy13]

Precedex in 10 mcg increments can smooth out a squirrelly kid in the PACU. Occasionally we have a kid who earns himself a squirt of physostigmine for suspected central anticholinergic syndrome. Propofol can work too, but more of my (previous) attendings are using precedex in this scenario.

 

[Intubate]

clonidine 1 mcg/kg iv. can repeat once or twice. never, ever fails.

 

[sevoflurane]

Propofol or dexmedetomidine. Propofol will always work faster, but can be short lived. Agree with deep extubation.

 

[proman]

Don't use sevo.

 

[IlDestriero]

1. Accept that emergence delirium is unavoidable in some children.
2. Adequate pain control at emergence. I also prefer dilaudid over morphine and fentanyl.
3. Clonidine, droperidol, dexmet. etc all work, though I don't typically use them.
4. Desflurane. It seems to lessen the duration, probably by coming off faster.
5. Prop on extubation if wild.
6. Get Ma and/or Pa to the bedside early, though it may not help for a severe case, or if they just want to watch TV and sleep in the corner.😴

 

[soorg]

We don't have dex at our facilities. What dose of Demerol: 12.5 vs 25, depending on size of kid I guess? Anybody try midaz?

 

[sevoflurane]

We don't have dex at our facilities. What dose of Demerol: 12.5 vs 25, depending on size of kid I guess? Anybody try midaz?

Can burn you from time to time and actualy make them more combative. I use it pre-op sometimes, never post-op.

 

[blaithnaid]

Can burn you from time to time and actualy make them more combative. I use it pre-op sometimes, never post-op.

Heh.

Keeping your cool helps too... nothing like a worked-up kid surrounded by a bunch of adults freaking out.

But that goes along with IlDest's first point.