Pediatrik Cerrahi Hastalarında Anestezi Sonrası Deliryum Yönetiminde Hemşirelik Girişimleri

Yıl 2025, Cilt: 9 Sayı: 3, 86 - 96, 30.12.2025

Nurcan Karamercimek , İlknur Yıldız

Öz

Anestezi sonrası deliryum (ASD), pediatrik cerrahi sonrası erken dönemde ortaya çıkan ajitasyon, huzursuzluk ve davranış değişiklikleriyle seyreden önemli bir postoperatif komplikasyondur. Çocuklarda sık görülen ASD, erken dönemde fark edilmediğinde ciddi sonuçlara yol açabilmektedir. Bu durum hastanın yataktan düşmesi, damar yolu veya cerrahi alanda hasar oluşması, iyileşme süresinin uzaması ve uzun vadede davranışsal sorunların gelişmesi gibi çeşitli komplikasyonlarla sonuçlanabilmektedir. Bu nedenle hemşireler, perioperatif dönemin tüm aşamalarında çocuğun davranışsal ve fizyolojik durumunu izleme, risk faktörlerini belirleme, uygun değerlendirme ölçeklerini kullanma ve zamanında müdahale etme açısından kritik bir role sahiptir. Güncel kanıtlar anne sesi, göz bandı uygulamaları, çevresel ışık düzenlemeleri ve perioperatif iletişim yöntemleri gibi nonfarmakolojik yaklaşımların ASD’yi azaltmada etkili olduğunu; farmakolojik yöntemler arasında ise özellikle deksmedetomidinin belirgin yarar sağladığını göstermektedir. Bu derleme, pediatrik cerrahi hastalarda ASD’nin tanılanması ve yönetiminde hemşirelik uygulamalarını güncel kanıtlar doğrultusunda ele alarak, güvenli ve bütüncül bakımın önemini vurgulamayı amaçlamaktadır.

Anahtar Kelimeler

Anestezi sonrası deliryum , çocuk sağlığı , hemşirelik bakımı , perioperatif dönem

Nursıng Interventıons In The Management Of Emergence Delırıum After Anaesthesıa In Paedıatrıc Surgery Patıents

Öz

Emergence delirium (ED) is an important postoperative complication that occurs in the early period after pediatric surgery and is characterized by agitation, restlessness, and behavioral changes. ED is common among children, and if not recognized early, it can lead to serious consequences. These may include complications such as falls from the bed, damage to intravenous lines or surgical sites, prolonged recovery time, and long-term behavioral problems. Therefore, nurses play a critical role throughout all phases of the perioperative period by monitoring the child’s behavioral and physiological status, identifying risk factors, using appropriate assessment tools, and providing timely interventions. Current evidence indicates that non-pharmacological approaches—such as maternal voice, eye mask application, environmental light adjustments, and perioperative communication techniques—are effective in reducing ED, while dexmedetomidine stands out as a particularly beneficial pharmacological option. This review aims to highlight the importance of safe and holistic care by addressing nursing practices in the identification and management of ED in pediatric surgical patients in line with up-to-date evidence.

Anahtar Kelimeler

Emergence delirium , child health , nursing care , perioperative period

Kaynakça

• 1. Chen, Y.C., Hung, I.Y., Hung, K.C., Chang, Y.J., Chu, C.C., Chen, J.Y., Ho, C.H. ve Yu, C.H. (2023). Incidence change of postoperative delirium after implementation of processed electroencephalography monitoring during surgery: A retrospective evaluation study. BMC Anesthesiology, 23(330). https://doi.org/10.1186/s12871-023-02293-9
• 2. Aoyama, K., Furuta, M., Ameye, L., Petre, M.A., Englesakis, M., Rana, M., Gai, N., Peliowski, A. ve Saha, B. (2025). Risk factors for pediatric emergence delirium: A systematic review. Canadian Journal of Anesthesia, 72(3), 384–396. https://doi.org/10.1007/s12630-024-02889-w
• 3. Petre, M.A., Saha, B., Kasuya, S., Englesakis, M., Gai, N., Peliowski, A. ve Aoyama, K. (2021). Risk prediction models for emergence delirium in paediatric general anaesthesia: A systematic review. BMJ Open, 11(e043968). https://doi.org/10.1136/bmjopen-2020-043968
• 4. Moyo, P., Francis, K., Kornhaber, R., Podham, M. ve Rossiter, R.C. (2025). Peri-operative nurses’ experiences of recognizing and responding to post-anesthetic pediatric emergence delirium: A narrative review. SAGE Open Nursing, 11(0), 1–14. https://doi.org/10.1177/23779608251389303
• 5. Karasu, D., Karaca, U., Ozgunay, S. E., Yilmaz, C., Yetik, F. ve Ozkaya, G. (2021). The frequency of emergence delirium in children undergoing outpatient anaesthesia for magnetic resonance imaging. International Journal of Clinical Practice, 75(11), e14763. https://doi.org/10.1111/ijcp.14763
• 6. Earwaker, M., Anderson, N. ve Egli, V. (2024). Developing nursing interventions in paediatric emergence delirium: A scoping review. Australian Occupational Therapy Journal, 71(2), 82–95. https://doi.org/10.1080/10376178.2024.2319852
• 7. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
• 8. Klabusayová, E., Musilová, T., Fabián, D., Skříšovská, T., Vafek, V., Kosinová, M., Ťoukálková, M., Vrtková, A., Klučka, J. ve Štourač, P. (2022). Incidence of emergence delirium in the pediatric pacu: Prospective observational trial. Children, 9(1591). https://doi.org/10.3390/children9101591
• 9. Özaltun, F., Ülgen Zengin, S., Orhon Ergün, M., Çorman Dinçer, P. ve Umuroğlu, T. (2022). Pediyatrik hastalarda postoperatif deliryum gelişmesi ile analjezi nosisepsiyon indeks değerleri arasındaki ilişkinin belirlenmesi. İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 14(2), 113-119. https://doi.org/10.14744/iksstd.2021.54366
• 10. Menser, C. ve Smith, H. (2020). Emergence agitation and delirium: Considerations for epidemiology and routine monitoring in pediatric patients. Local and Regional Anesthesia, 13, 73–83. https://doi.org/10.2147/LRA.S181459
• 11. Holly, C., Porter, S., Echevarria, M., Dreker, M. ve Ruzehaji, S. (2018). CE: Original research: Recognizing delirium in hospitalized children: A systematic review of the evidence on risk factors and characteristics. American Journal of Nursing, 118(4), 24–36. https://doi.org/10.1097/01.NAJ.0000532069.55339.f9
• 12. Norman, S., Taha, A.A. ve Turner, H.N. (2017). Delirium in the critically ill child. Clinical Nurse Specialist, 31(5), 276–284. https://doi.org/10.1097/NUR.0000000000000324
• 13. Russell, P.S.S., Mammen, P.M., Shankar, S.R., Viswanathan, S.A., Rebekah, G., Russell, S., Earnest, R. ve Chikkala, S.M. (2022). Pediatric anesthesia emergence delirium scale: A diagnostic meta-analysis. World Journal of Clinical Pediatrics, 11(2), 196-205. https://doi.org/10.5409/wjcp.v11.i2.196
• 14. Kim, K., Jeong, J.H. ve Choi, E.K. (2024). Non-pharmacological interventions for delirium in the pediatric population: A systematic review with narrative synthesis. BMC Pediatrics, 24(108). https://doi.org/10.1186/s12887-024-04595-4
• 15. MacDonald, I., de Goumoëns, V., Marston, M., Alvarado, S., Favre, E., Trombert, A., Perez, M.H. ve Ramelet, A.S. (2023). Effectiveness, quality and implementation of pain, sedation, delirium, and iatrogenic withdrawal syndrome algorithms in pediatric intensive care: a systematic review and meta-analysis. Frontiers in Pediatrics, 11(1204622). https://doi.org/10.3389/fped.2023.1204622
• 16. Moore, A.D. ve Anghelescu, D.L. (2017). Emergence delirium in pediatric anesthesia. Paediatric Drugs, 19(1), 11–20. https://doi.org/10.1007/s40272-016-0201-5
• 17. Chen, Y.C., Foster, J., Wang, M.L., Rohmah, I., Tseng, Y.H. ve Chiu, H.Y. (2024). Global prevalence and risk factors of emergence delirium in pediatric patients undergoing general anesthesia: A systematic review and meta-analysis. Journal of Pediatric Nursing, 77, 74–80. https://doi.org/10.1016/j.pedn.2024.03.010
• 18. Ercan, İ. ve Kızıler, E. (2021). Pediatri yoğun bakımlarda deliryum yönetiminde hemşirenin sorumlulukları ve rolleri. Türkiye Sağlık Bilimleri ve Araştırmaları Dergisi, 4(1), 67-78. https://doi.org/10.51536/tusbad.832764
• 19. Reduque, L.L. ve Verghese, S.T. (2013). Pediatric emergence delirium. Continuing Education in Anaesthesia Critical Care and Pain, 13(2), 39–41. https://doi.org/10.1093/bjaceaccp/mks051
• 20. Sarman, A. ve Sarman, E. (2020). Deliryumdaki pediatrik yoğun bakım hastalarına hemşirelik yaklaşımı. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu Dergisi, 8(3), 964–972. https://doi.org/10.33715/inonusaglik.726409
• 21. Devi, E.A., Nagaprasad, Y.V., Shiva, P.V. ve Nirmalan, P. (2023). Incidence and risk factors for emergence delirium in children undergoing surgery under general anaesthesia: A prospective, observational study. Indian Journal of Anaesthesia, 67(8), 725–729. https://doi.org/10.4103/ija.ija_784_22
• 22. Kahraman Berberoğlu, B. ve Çalışır, H. (2020). Pediatrik yoğun bakım ünitesinde yatan hastalarda deliryumun tanılanması ve hemşirelik yönetimi. Ebelik ve Sağlık Bilimleri Dergisi, 3(3), 233–243.
• 23. Sılay, F. ve Akyol, A. (2018). Yoğun bakım ünitelerinde sedasyon-ajitasyon ve ağrı değerlendirmesinde kullanılan iki ölçüm aracının Türkçe’ye uyarlanması: Geçerlik ve güvenirlik çalışması. Yoğun Bakım Hemşireliği Dergisi, 22(2), 50–65.
• 24. Shin, S.A., Evans, F. ve Mason, K. (2021). Emergence delirium in pediatric patients. Anaesthesia Tutorial of the Week, 442, 1–6.
• 25. Wang, Y., Wang, L., Liang, N. ve Wang, K. (2025). Effect of video-based interventions on emergence delirium in pediatric patients: A systematic review and meta-analysis of randomized controlled trials. Jornal de Pediatria, 101(1), 21-29. https://doi.org/10.1016/j.jped.2024.06.016
• 26. Shi, X., Su, L., Sun, Y., Ma, C. ve Wang, Z. (2024). Non-pharmacological interventions for preventing emergence delirium in children under general anesthesia: A scoping review. Journal of Pediatric Nursing, 77, 38–53. https://doi.org/10.1016/j.pedn.2024.03.014
• 27. Hsu, Y.C., Wang, S.Y., Su, S.F. ve Lin, L.W. (2025). A study of knowledge and recognition on postoperative delirium among postanesthesia care unit (PACU) nurses. Journal of PeriAnesthesia Nursing, 40(6), 627–633. https://doi.org/10.1016/j.jopan.2024.07.019
• 28. Yılmaz, M. ve Türkleş, S. (2018). Terminal dönemdeki çocuklarda öfke, yalnızlık ve delirium yönetimi. Cimete, G. (Ed.), Çocuklarda palyatif bakım: Terminal dönemdeki çocuk ve aileye yaklaşım. Türkiye Klinikleri Yayınları, Ankara, 72–78.
• 29. Lin, L., Peng, Y., Zhang, H., Huang, X., Chen, L. ve Lin, Y. (2022). Family- centred care interventions to reduce the delirium prevalence in critically ill patients: A systematic review and meta- analysis. Nursing Open, 9, 1933–1942. https://doi.org/10.1002/nop2.1214
• 30. Gao, Y., Pei, H., Liu, Z., Bai, Y., Liu, J. ve Ni, X. (2025). Association between family environment and emergence delirium in pediatric patients after tonsillectomy and adenoidectomy: An observational prospective study. Brazilian Journal of Anesthesiology, 75(6), 844676. https://doi.org/10.1016/j.bjane.2025.844676
• 31. Byun, S., Song, S., Kim, J.H., Ryu, T., Jeong, M.Y. ve Kim, E. (2018). Mother’s recorded voice on emergence can decrease postoperative emergence delirium from general anaesthesia in paediatric patients: A prospective randomised controlled trial. British Journal of Anaesthesia, 121(2), 483–489. https://doi.org/10.1016/j.bja.2018.01.042
• 32. In, W.Y., Kim, Y.M., Kim, H.S., Hong, S.H., Suh, Y.R., Cha, Y., Kim, N., Kim, J., Kang, H., Kwon, H., Kim, Y. ve Park, W. (2018). The effect of a parental visitation program on emergence delirium among postoperative children in the PACU. Journal of PeriAnesthesia Nursing, 34(1), 108–116. https://doi.org/10.1016/j.jopan.2018.04.003
• 33. Pan, Y., Zhuang, J., Zeng, J., Chen, M., Bo, Z., Fang, L., Sun, X., Yin, X. ve Song, H. (2019). Preoperative blindfold training prevents pediatric psychological behavior disorders during the anesthesia recovery period: A randomized controlled trial. Journal of PeriAnesthesia Nursing, 34(6), 1206-1214. https://doi.org/10.1016/j.jopan.2019.03.016
• 34. Wennström, B., Törnhage, C.J., Nasic, S., Hedelin, H. ve Bergh, I. (2011). The perioperative dialogue reduces postoperative stress in children undergoing day surgery as confirmed by salivary cortisol. Pediatric Anesthesia, 21(10), 1058–1065. https://doi.org/10.1111/j.1460-9592.2011.03656.x
• 35. Adler, A.C., Nathanson, B.H. ve Chandrakantan, A. (2021). Monochromic light reduces emergence delirium in children undergoing adenotonsillectomy; a double-blind randomized observational study. BMC Anesthesiology, 21(1), 217. https://doi.org/10.1186/s12871-021-01435-1
• 36. Frelich, M., Lečbychová, K., Vodička, V., Ekrtová, T., Sklienka, P., Jor, O., Straková, H., Bílená, M., Formánek, M. ve Burša, F. (2024). Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective randomized controlled trial. Anaesth Crit Care Pain Med, 43, 101318. https://doi.org/10.1016/j.accpm.2023.101318
• 37. Shi, M., Miao, S., Gu, T., Wang, D., Zhang, H. ve Liu, J. (2019). Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: A double-blind, randomized trial. Drug Design, Development and Therapy, 13, 897–905. https://doi.org/10.2147/DDDT.S196075
• 38. Ng, K.T., Lim, W.E., Teoh, W.Y. ve Zainal Abidin, M.F.B. (2024). The effect of nalbuphine on prevention of emergence delirium in children: A systematic review with meta-analysis. Brazilian Journal of Anesthesiology, 74(5), 844543. https://doi.org/10.1016/j.bjane.2024.844543
• 39. Buss, H. E. ve Melderis, K. (2002). PACU pain management algorithm. American Society of Peri Anesthesia Nurses, 17(1), 11–20. https://doi.org/10.1053/jpan.2002.30245
• 40. Bilgen, S., Köner, Ö., Karacay, S., Sancar, N.K., Kaspar, E.C. ve Sözübir, S. (2014). Effect of ketamine versus alfentanil following midazolam in preventing emergence agitation in children after sevoflurane anaesthesia: A prospective randomized clinical trial. Journal of International Medical Research, 42(6), 1262–1271. https://doi.org/10.1177/0300060514543039