40-Hz Light Stimulation and Emergence Delirium Incidence After Sevoflurane Anesthesia in Children: A Randomized Clinical Trial

Importance: Emergence delirium is common in children undergoing surgery under general anesthesia and is associated with prolonged recovery times and an increased risk of postoperative behavioral disturbances. Light stimulation, 40 Hz, has shown promise for cognitive modulation, but evidence for mitigating emergence delirium is limited. 

Objective: To evaluate the effects of 40-Hz light stimulation in reducing emergence delirium. Design, Setting, and Participants: This randomized clinical trial was conducted from April to August 2024 at a single tertiary center (Henan Provincial People's Hospital). Children aged 3 to 14 years scheduled for elective vascular malformation resection were included. Children were excluded if they refused consent, had intellectual disability, neuropsychiatric disorders (or history thereof), severe hepatic or kidney dysfunction, severe cardiopulmonary disorders, autoimmune disorders, cephalofacial vascular malformations, or major life changes within 1 month preoperatively. Interventions: Participants were randomized 1:1 to 40-Hz light stimulation via virtual reality glasses or sham (identical glasses without light) for 1 hour after induction. 

Main Outcomes and Measures: The primary efficacy end point was emergence delirium incidence, defined as a score of 10 or higher on the Chinese version of the Cornell Assessment of Pediatric Delirium (C-CAPD) scale between extubation and 72 hours postsurgery. 

Results: Ninety-eight children were randomized (49 per group; mean [SD] age, 7.7 [3.2] years; 59 [60.2%] male). More children had an excellent outcome with 40-Hz light stimulation than with sham stimulation (C-CAPD score, 22.4% vs 44.9%, unadjusted risk ratio, 0.57; 95% CI, 0.33-0.92; P =.02). Similar results were obtained when assessing emergence delirium using the Pediatric Anesthesia Emergence Delirium scale (14.3% vs 34.7%; unadjusted risk ratio, 0.51; 95% CI, 0.26-0.91; P =.02). After adjusting for age, sex, preoperative anxiety, anesthesia time, postoperative pain, and history of surgical procedures, 40-Hz light stimulation remained significantly associated with reduced incidence of emergence delirium (adjusted risk ratio, 0.86; 95% CI, 0.77-0.95; P =.004). 

Conclusions and Relevance: In this randomized clinical trial of children undergoing vascular malformation surgery, 40-Hz light stimulation was associated with a lower incidence of emergence delirium. These findings support further evaluation of nonpharmacologic sensory stimulation to prevent pediatric emergence delirium. Trial Registration: ClinicalTrials.gov Identifier: NCT06493513.