Non-pharmacological interventions for preventing emergence delirium in children under general anesthesia: A scoping review.

Researchers conducted a comprehensive review to understand how non-drug approaches might help prevent emergence delirium—a condition where children become confused, agitated, or distressed when waking up from general anesthesia. This scoping review examined 32 studies involving 4,633 children under age 18 who underwent elective surgery. The researchers identified 10 different non-pharmacological interventions that have been tested, including distraction techniques, showing children videos of the operating room beforehand (visual preconditioning), virtual reality, having parents present, playing recordings of the mother's voice, allowing light drinking before surgery, acupuncture, music or auditory stimulation, special lighting, and breathing exercises. The studies measured three main outcomes: emergence delirium itself, anxiety before surgery, and pain after surgery. What the researchers found was that while many of these approaches have been tried, the evidence for their effectiveness varies considerably. Visual preconditioning and distraction interventions appear to be promising areas showing particular interest in recent research. For families considering acupuncture as one option to help prevent emergence delirium in children undergoing surgery, this review suggests it is among the non-drug approaches being studied, though more research is needed to fully understand its effectiveness compared to other methods. Parents should discuss all available options with their child's surgical team to determine the best approach for their individual situation. If considering acupuncture, it's essential to work with a licensed acupuncturist who has specific training and experience in pediatric care.

This scoping review, conducted per Arksey and O'Malley's framework and PRISMA-ScR guidelines, systematically analyzed non-pharmacological interventions for preventing pediatric emergence delirium. The review included 32 studies (29 RCTs) with 4,633 patients aged 0-18 years undergoing elective surgery under general anesthesia. Ten distinct interventions were identified: distraction, visual preconditioning, virtual reality, parental participation, maternal voice, light drinking, acupuncture, auditory stimulation, monochromic light, and breathing training. Primary outcomes assessed were emergence delirium, preoperative anxiety, and postoperative pain, measured using four validated instruments. The authors note that acupuncture was among the interventions evaluated, though specific effect sizes were not reported in the abstract. The review concludes that while multiple non-pharmacological approaches exist, evidence for effectiveness varies, with visual preconditioning and distraction interventions emerging as particularly promising areas warranting further investigation. Clinical takeaway: Multiple non-pharmacological options exist for preventing pediatric emergence delirium, though practitioners should recognize that evidence quality and intervention effectiveness remain heterogeneous across approaches.