Identifying Pediatric Emergence Delirium by Using the PAED Scale: A Quality Improvement Project

Pediatric emergence delirium is a postoperative phenomenon characterized by aberrant cognitive and psychomotor behavior, which can place the patient and health care personnel at risk for injury. A common tool for identifying emergence delirium is the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS), although it has not been validated for use in the pediatric population. The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a newly validated tool to measure emergence delirium in children. We chose to implement and evaluate the effectiveness and fidelity of using the PAED Scale to identify pediatric emergence delirium in one eight-bed postanesthesia care unit in comparison with the traditional LOC-RASS. The overall incidence of pediatric emergence delirium found by using the LOC-RASS with a retrospective chart review (3%) was significantly lower than the incidence found by using the LOC-RASS (7.5%) and PAED Scale (11.5%) during the implementation period. Our findings suggest that the PAED Scale may be a more sensitive measure of pediatric emergence delirium, and, in the future, we recommend that health care personnel at our facility use the PAED Scale rather than the LOC-RASS.     

Evaluating drug effects on children''s cognitive functioning

1. In our studies of drug therapy in child psychiatry disorders, we have been using a battery of tests to monitor any effects of medication on the various components of cognitive processing. Our intention was to measure skills required by the children for successful classroom performance.

2. We have used used this test battery approach in open clinical trials of bupropion (Wellbutrin) and of alprazolam (Xanax) with child psychiatry patients.

3. On no single test was the effect of bupropion vs placebo significant; however, there was no indication of any cognitive deterioration with bupropion. Group performance with alprazolam was more variable, and again no individual test showed significant changes with medication.

4. These initial applications of the cognitive battery indicate that bupropion, a new anti- depressant and alprazolam, an anxiolytic have no adverse effects on cognition at therapeutically effective doses.     

Should drainage be performed in perforated appendicitis?

During a follow-up study we examined 85 patients (34 children) with perforated appendicitis. The operating procedure is shortly sketched. The very favourable early and late results of our patients confirm the findings of other authors [2, 4, 5] that an intraperitoneal drainage is unnecessary in patients with perforated appendicitis. We take a thick Penrose drain for any abscess within a capsule.     

Detection of heterozygotes in both parents of homozygous patients with Von Willebrand's disease.

Three patients with severe Von Willebrand's disease are shown to be homozygotes. They were born from unaffected parents. New techniques using a factor-VIII-related antigen assay by the Laurell method and a ristocetin-induced platelet aggregation assay demonstrated abnormalities in these two tests in both parents of the probands. Factor-VIII-related of heterogotes could not be differentiated from normal factor-VIII-related antigen by the immunodiffusion technique, crossed immunoelectrophoresis, and filtration on a sepharose 4b column.