Work by Kristine McKenna, PhD, and Chase Samsel, MD, is shedding light on a disconcerting — but normal — side effect of surgery in transplant patients.

The idea of having their child sedated or given anesthesia for a surgical procedure can be worrying for many parents — so it can be even more alarming if that child has trouble waking up and recovering afterward. Known as delirium, this phenomenon can include grogginess, confusion, agitation and other symptoms, which can last anywhere from a few minutes (after a minor procedure) to several days (for children in intensive care units, or ICUs). As scary as delirium can be for both kids and their parents, it’s relatively common and can be managed.

To learn more about why certain patients are prone to post-operative and ICU delirium, Boston Children’s transplant psychologist Kristine McKenna, PhD, and psychiatrist Chase Samsel, MD, are identifying potential risk factors and investigating approaches to prevent the problem. “We noticed that we were receiving a number of requests for consults, especially for kids in the ICU,” says McKenna. “We want to get a better handle on the frequency of delirium in transplant patients and how to reduce that.”

Simple approaches, big results

During the pre-transplant evaluation, McKenna asks families if their child has had a difficult time waking up after anesthesia or sedation for previous procedures, such as dental surgery or a cardiac catheterization. She also asks whether other family members have experienced symptoms of delirium after surgery, since a family history can indicate a higher likelihood of post-operative delirium in children. Other risk factors include electrolyte imbalance, infection and certain medications.

Based on these findings, Samsel then works with the patient’s care team to reduce the chances of delirium. “Together, we try to find the best sedative or type of anesthesia that will have the least amount of impact on that individual patient’s emotions and behavior,” he explains.

In addition to medical management, Samsel and McKenna collaborate with nurses, social workers, neuropsychologists, child life specialists, physical therapists and other members of the team to examine how aspects of the hospital environment can influence delirium. “Simple things can have a big effect on recovery, like keeping lights on during the day and dimming them at night to improve the child’s sleep-wake cycle,” says McKenna. “Physical therapy can help get patients up and engaged. It’s a true interdisciplinary effort.”

Families themselves can play an integral role in recovery, too. The pair has found that familiarity can help calm kids and provide structure, so they recommend that parents bring orientating items to the hospital, such as the child’s favorite blanket or stuffed animal, family photos and music they enjoy. Allowing kids to watch their preferred cartoons or other TV shows at the usual time a day can also help them get back into their normal schedule and routine.

Empowering families

McKenna and Samsel are the process of getting the word out to a larger audience: Samsel has given talks to nursing staff at Boston Children’s, and both have presented their findings at various professional conferences, including the International Pediatric Transplant Association’s biannual meeting. They hope to publish their research in the future. “There are very few studies on this topic in the pediatric transplant community,” says Samsel. “We’re really excited about it.”

In the meantime, they want parents to know that they can help address post-operative delirium in their children. “It can be concerning to see your child experiencing this, especially if you aren’t expecting it,” says McKenna. “We want families to understand that they are the experts on their kids and can be active participants in their recovery.”