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Distress during the induction of anesthesia and postoperative behavioral outcomes
Z N Kain1, S M Wang, L C Mayes
1Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA. kain@biomed.med.yale.edu
Insights
Children experiencing high anxiety during anesthesia induction are more prone to negative behavioral changes post-surgery. Anesthesiologists should inform parents about this increased risk for anxious children.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Behavioral Science
Background:
- Preoperative anxiety in children is a common concern.
- Postoperative behavioral changes can impact recovery and family well-being.
- Understanding predictors of these changes is crucial for effective management.
Purpose of the Study:
- To investigate the association between extreme anxiety during anesthesia induction and the development of negative postoperative behavioral changes in children.
- To identify predictors of postoperative maladaptive behavior in pediatric surgical patients.
Main Methods:
- A cohort of 91 children (aged 1-7 years) undergoing general anesthesia for elective outpatient surgery were recruited.
- Preoperative anxiety and postoperative behaviors were assessed using validated measures on multiple postoperative days (1, 2, 3, 7, 14).
- Multivariate logistic regression analysis was employed to determine predictors of negative behavioral changes.
Main Results:
- Childhood anxiety during anesthesia induction, time after surgery, and surgical procedure type were significant predictors of postoperative maladaptive behavior.
- The frequency of negative behavioral changes decreased over time post-surgery.
- A significant positive correlation (r=0.42, P=0.004) was found between induction anxiety and postanesthesia care unit excitement scores.
Conclusions:
- Children exhibiting high anxiety during anesthesia induction face an increased risk of developing negative postoperative behavioral changes, including nightmares, separation anxiety, and aggression.
- Anesthesiologists should counsel parents of anxious children about this heightened likelihood of adverse behavioral outcomes.
Unlabelled:
We determined whether children who are extremely anxious during the induction of anesthesia are more at risk of developing postoperative negative behavioral changes compared with children who appear calm during the induction process. Children (n = 91) aged 1-7 yr scheduled for general anesthesia and elective outpatient surgery were recruited. Using validated measures of preoperative anxiety and postoperative behaviors, children were evaluated during the induction of general anesthesia and on Postoperative Days 1, 2, 3, 7, and 14. Using a multivariate logistic regression model, in which the dependent variable was the presence or absence of postoperative negative behavioral changes and the independent variables included several potential predictors, we demonstrated that anxiety of the child, time after surgery, and type of surgical procedure were predictors for postoperative maladaptive behavior. The frequency of negative postoperative behavioral changes decreased with time after surgery, and the frequency of negative postoperative behavioral changes increased when the child exhibited increased anxiety during the induction of anesthesia. Finally, we found a significant correlation (r) of 0.42 (P = 0.004) between the anxiety of the child during induction and the excitement score on arrival to the postanesthesia care unit. We conclude that children who are anxious during the induction of anesthesia have an increased likelihood of developing postoperative negative behavioral changes. We recommend that anesthesiologists advise parents of children who are anxious during the induction of anesthesia of the increased likelihood that their children will develop postoperative negative behavioral changes such as nightmares, separation anxiety, and aggression toward authority.
Implications:
Anesthesiologists who care for children who are anxious during the induction of anesthesia should inform parents that these children have an increased likelihood of developing postoperative negative behavioral changes.