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Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane
Insights
Children who are anxious before anesthesia are more likely to experience emergence delirium. This study found a significantly higher incidence of problematic behavior in anxious boys compared to calm boys post-halothane anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
Background:
- Pre-anesthetic anxiety in children is clinically associated with emergence agitation.
- Understanding predictors of emergence delirium is crucial for pediatric patient care.
Purpose of the Study:
- To investigate the relationship between pre-anesthetic anxiety and emergence behavior in pediatric surgical patients.
- To determine if pre-operative anxiety predicts problematic emergence behavior after halothane anesthesia.
Main Methods:
- A cohort of 110 boys (aged 3-6 years, ASA 1) undergoing circumcision were categorized into anxious and calm groups based on pre-induction behavior.
- Anesthesia was induced and maintained with halothane. All patients received caudal block with bupivacaine and topical lidocaine for analgesia.
- The incidence of delirium on emergence was compared between the anxious and calm groups.
Main Results:
- Exclusion of 4 boys with incomplete pain relief left 106 participants.
- Twenty of 27 boys in the anxious group exhibited problematic emergence behavior.
- This contrasts with 5 of 79 boys in the calm group, showing a statistically significant difference.
Conclusions:
- Pre-anesthetic anxiety in boys is a significant predictor of problematic emergence behavior following halothane anesthesia.
- Calmness prior to anesthesia is associated with a lower incidence of emergence agitation.
- These findings highlight the importance of addressing pre-operative anxiety in pediatric surgical settings.
Background:
In our clinical experience, children who are crying before anesthesia are more likely to show agitated behavior on emergence.
Methods:
One hundred and ten boys aged 3-6 years old (ASA 1) who underwent circumcision were studied. The children were assigned to one of two groups, depending on their attitude during induction: the anxious group and the calm group. Anesthesia was induced by inhalation of halothane in oxygen, and was maintained at 1% throughout surgery. For intra- and postoperative analgesia, caudal block with 0.5 ml/kg of 0.25% plain bupivacaine and topical infiltration with 1 to 2 ml of 1% lidocaine were provided for all patients. The incidence of delirium on emergence was compared between the groups.
Results:
We excluded 4 boys showing signs of incomplete pain relief. Twenty of 27 boys in the anxious group showed a significantly greater incidence of problematic behavior on emergence, compared to 5 of 79 in the calm group.
Conclusion:
The boys who were anxious before anesthesia showed a significantly greater incidence of problematic behavior on emergence from halothane anesthesia, compared with the boys who were calm before anesthesia.