Monochromic light reduces emergence delirium in children undergoing adenotonsillectomy; a double-blind randomized observational study

Abstract

Background: Emergence delirium (ED) is common in pediatric anesthesia. This dissociative state in which the patient is confused from their surroundings and flailing can be self-injurious and traumatic for parents. Treatment is by administration of sedatives which can prolong recovery. The aim of this study was to determine if exposure to monochromatic blue light (MBL) in the immediate phase of recovery could reduce the overall incidence of emergence delirium in children following general inhalational anesthesia.

Methods: This double blinded randomized controlled study included patients ages 2-6 undergoing adenotonsillectomy. Postoperatively, 104 patients were randomization (52 in each group) for exposure to sham blue or MBL during the first phase (initial 30 min) of recovery. The primary outcome was the incidence of emergence delirium during the first phase. We also examined Pediatric Anesthesia Emergence Delirium (PAED) scores throughout the first phase.

Results: Emergence Delirium was reported in 5.9% of MBL patients versus 33.3% in the sham group, p = 0.001. Using logistic regression adjusting for age, weight, gender, ASA classification and PAED scores provided an adjusted relative risk ratio of 0.18; 95% CI (0.06, 0.54); p = 0.001 for patients in the MBL group. 23.5% of MBL patients versus 52.9% of sham patients had either ED or PAED scores of 12 or more throughout the first phase of recovery, p = 0.002. This produced an adjusted relative risk of 0.46, 95% CI (0.29, 0.75), p = 0.001.

Conclusions: Monochromatic blue light represents a non-pharmacologic method to reduce the incidence of emergence delirium and PAED scores in children.

Trial registration: #NCT03285243 registered on 15/09/2017.

Keywords: Blue light; Delirium; Emergence; Monochromatic light; Pediatric.

Fig. 1

Flowchart of patient enrollment. PACU = post anesthesia care unit

Fig. 2

Percent change in Pediatric Anesthesia Emergence Delirium (PAED) score between patients exposed to monochromatic blue light (study) and those exposed to polychromatic sham blue light (control)