Perioperative variables associated with emergence delirium in children following strabismus surgery: A five-year retrospective single-center cohort study

Background
Emergence Delirium (ED) is common among children. Several factors have been linked to ED related to patient characteristics, anesthesia, or the type of surgery. Strabismus surgery has been associated with the development of ED. The aim of this study was to determine the perioperative variables associated with ED after strabismus surgery in children.
Methodology
A retrospective cohort study of children who underwent strabismus surgery from January 2018 to December 2022 was conducted. Data on factors leading to ED, including patient characteristics, preoperative anxiety, postoperative pain, surgery-related characteristics anesthesia-related characteristics, were analyzed. Emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale.
Results
Three-hundred-and-thirty-six children were included in the analysis. Fourteen percent of patients developed ED. Predictors of ED were age, multiple muscle surgery, binocular surgery. Midazolam premedication, intraoperative dexmedetomidine and fentanyl were associated with lower incidence of ED. On multivariable analysis, younger age (Odds Ratio (OR) = 1.05;  = 0.039), multiple muscle correction (OR = 1.91;  = 0.041), binocular surgery (OR = 1.85;  = 0.021) midazolam premedication (OR = 2.02;  = 0.007), intraoperative fentanyl administration (OR = 1.88;  = 0.031), and intraoperative dexmedetomidine administration (OR = 1.32;  < 0.001), were independent predictors of ED.
Conclusion
In this study, younger age, multiple muscle surgery, and binocular surgery were the main non-modifiable factors associated with ED in children following strabismus surgery. Administration of midazolam, dexmedetomidine, or fentanyl were associated with lower incidence of ED. Patients at higher risk for ED could be selected for prophylaxis against ED using these medications to prevent ED after strabismus correction surgery in children.