Emergence agitation (EA) remains one of the most distressing complications following general anesthesia in pediatric populations. Characterized by restlessness, disorientation, and inconsolable crying, EA poses risks of physical injury to the patient, increases the workload for recovery room staff, and causes significant anxiety for parents. A randomized clinical trial published in Medicine (February 2026) investigates a non-invasive intervention familiar to many rehabilitation professionals: Transcutaneous Acupoint Electrical Stimulation (TEAS).
The Burden of Emergence Agitation in Tonsillectomy
Tonsillectomy is a common procedure in pediatric otolaryngology, yet it carries a high incidence of EA. Factors contributing to this phenomenon include rapid awakening, pain, and the stress response associated with an unfamiliar environment. Traditional pharmacological interventions often come with side effects, such as respiratory depression or prolonged sedation. Consequently, there is a growing interest in multimodal, non-pharmacological approaches to modulate the autonomic nervous system and manage perioperative stress.
Study Methodology and TEAS Application
The study, conducted by Li et al., enrolled 97 pediatric patients undergoing tonsillectomy between January and May 2025. Participants were randomized into a control group and a TEAS group. The intervention protocol involved the application of TEAS at two specific acupoints during the surgical procedure:
- Hegu (LI4): Traditionally used for analgesia and stress reduction.
- Neiguan (PC6): Known for its regulatory effects on the heart and anti-emetic properties.
The researchers monitored a comprehensive set of physiological and biochemical markers, including cerebral oxygen saturation ($rSO_2$), mean arterial pressure (MAP), heart rate (HR), and stress hormones ($eta$-endorphin, norepinephrine, epinephrine, and cortisol).
Results: Oxygenation, Stress Hormones, and Hemodynamics
The findings demonstrated a significant preventative effect of TEAS on emergence agitation. The TEAS group exhibited lower Pediatric Anesthesia Emergence Delirium (PAED) scores compared to controls. Crucially, the study highlighted the physiological mechanisms potentially driving these behavioral improvements.
Patients receiving TEAS showed significantly reduced intraoperative consumption of remifentanil. Biochemically, the TEAS group displayed lower levels of systemic stress markers (NE, E, COR) and higher levels of $eta$-endorphin ($eta$-EP), suggesting an enhanced endogenous analgesic response. Furthermore, cerebral oxygen saturation was notably increased in the intervention group, implying that TEAS may play a neuroprotective role by maintaining better cerebral perfusion and oxygenation during anesthesia.
Hemodynamic stability was also superior in the TEAS group, with significantly lower mean arterial pressure and heart rate observed post-intubation compared to the control group. Patient satisfaction scores were correspondingly higher in the TEAS cohort.
Clinical Relevance for Pain and Autonomic Management
For professionals in orthopedic manipulation and physical therapy, this study reinforces the utility of transcutaneous electrical stimulation beyond local tissue healing. It validates the systemic impact of stimulating the Hegu and Neiguan points, demonstrating tangible modulation of the autonomic nervous system and stress axis. While physiotherapists generally do not manage intraoperative care, understanding the efficacy of TEAS in modulating cerebral oxygenation and dampening sympathetic overdrive supports its broader application in pain management and autonomic regulation protocols.
References
Li, X., Wu, T., Li, W., Xing, Q., & Bao, W. (2026). Preventive effect of transcutaneous acupoint electrical stimulation on emergence agitation after general anesthesia in pediatric patients undergoing tonsillectomy: A randomized clinical trial. Medicine. https://pubmed.ncbi.nlm.nih.gov/41686548/
