ObjectivesTo assess whether decreased regional cerebral oxygen saturation (rScO2) is associated with the emergence delirium (ED) following general anesthesia in the pediatric population.MethodsA retrospective observational cohort study was conducted on 113 children (ASA I–III) aged 2–14 years who underwent selective surgery under general anesthesia between 2022-01 and 2022-04. Intraoperatively, the rScO2was monitored using a cerebral oximeter. The Pediatric Anesthesia Emergence Delirium (PAED) score was used to evaluate the patients for ED.ResultsThe incidence of ED was 31%. Low rScO2was reported in 41.6% of patients, who had a higher incidence of ED (P< 0.001) than those who did not experience desaturation. Logistic regression analysis revealed that decreased rScO2was significantly associated with incident ED events [odds ratio (OR), 10.77; 95% confidence interval, 3.31–35.05]. Children under 3 years of age had a higher incidence of ED after rScO2desaturation during anesthesia compared to older children (OR, 14.17 vs. 4.64).ConclusionIntraoperative rScO2desaturation significantly increased the incidence of ED following general anesthesia. Monitoring should be enhanced to improve the oxygen balance in vital organs to improve the quality and safety of anesthesia.