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Interventions that have been shown to prevent emergence delirium in children

Interventions that have been shown to prevent emergence delirium in children
Medication Dose and timing
Propofol
  • TIVA
  • 1 mg/kg IV or 3 mg/kg IV at the end of anesthesia
Thiopental
  • 2 to 3 mg/kg IV after sevoflurane induction
Opioids
  • Fentanyl, remifentanil, sufentanil, alfentanil
  • Various doses IV
  • Nalbuphine
  • 0.1 mg/kg IV at the end of anesthesia
Benzodiazepines
  • Midazolam
  • 0.2 to 0.5 mg/kg orally preoperative
  • 0.03 to 0.05 mg/kg IV at the end of anesthesia
  • Remimazolam
  • 0.2 mg/kg IV at wound closure
  • 1 mg/kg/hour IV infusion throughout surgery
Alpha2 agonists
  • Dexmedetomidine
  • 0.2 mcg/kg IN preoperative
  • 1 mcg/kg IV followed by 0.5 to 1 mcg/hour IV through surgery
  • 0.3 to 1 mcg/kg IV at emergence
  • Clonidine
  • 2 mcg/kg IV at induction
  • 1 mcg/kg caudal
Ketamine
  • 1 mg/kg IV followed by 1 mg/kg/hour IV through surgery
  • 0.25 mg/kg IV bolus at the end of anesthesia
This table shows drugs and dose regimens that may prevent emergence delirium in children, based on published studies. For further information refer to UpToDate content on emergence delirium in children.
IN: intranasal; IV: intravenous; TIVA: total intravenous anesthesia.
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