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Emergence delirium — FRCA Final MCQ

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ModeratePaediatricEmergence deliriumFRCA Final

A 4-year-old develops agitation, inconsolable crying and thrashing 10 minutes after sevoflurane anaesthesia for MRI. He has normal observations, no surgical wound, and settles briefly when held by his parent before becoming distressed again. What is the most likely cause of the complication?

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Correct answer: B — Emergence delirium after sevoflurane anaesthesia

Agitation after short sevoflurane anaesthesia without a painful procedure or physiological abnormality is typical of emergence delirium. Pain should be considered, but the absence of surgical stimulus and normal observations make it less likely. LAST and hypoglycaemia would have different neurological or metabolic features. Management includes reassurance, reducing stimulation, parental presence and small doses of propofol or alpha-2 agonist where needed.

Reference: APAGBI paediatric recovery guidance; RCoA GPAS paediatric anaesthesia 2022