Management of intractable emergence agitation with emotional and behavioural disinhibition in a child with anxiety requiring multiple anaesthetics.

Paediatric oncology patients require multiple anaesthetics for diagnostic and therapeutic procedures. Anxiety due to major life stressors, repeated procedures and other cancer therapy is common among these patients and may contribute to the incidence of emergence agitation. Here, we present the case of a 9-year-old child with procedural anxiety and relapsed acute B-cell lymphoblastic leukaemia requiring multiple anaesthetics for various procedures. The patient experienced severe disinhibition and agitation without delirium upon anaesthesia emergence. After conventional pharmacological and non-pharmacological strategies were unsuccessful, the combination of olanzapine premedication with the ongoing anaesthetic regimen resolved her emergence agitation on multiple subsequent anaesthetics. We suggest a novel approach for the management of intractable emergence agitation and highlight the need for early involvement of mental health providers in the unique context of iterative anaesthesia in children with cancer.