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Assessment of risk factors for emergence distress and postoperative behavioural changes in children following general
Paul A Tripi1, Tonya Mizell Palermo, Susan Thomas
1Department of Anesthesiology, University Hospitals of Cleveland, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. paul.tripi@uhhs.com
Insights
Parental presence during anesthesia emergence did not reduce distress in children. However, factors like clinginess and temper tantrums were linked to increased emergence distress behavior.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Postoperative Care
Background:
- Emergence distress is common in children post-general anesthesia.
- Identifying factors influencing emergence distress is crucial for improving patient outcomes.
Purpose of the Study:
- To determine if parental presence during anesthesia emergence reduces distress behavior.
- To assess psychosocial risk factors for emergence distress in children.
Main Methods:
- A randomized controlled trial involving 100 children undergoing general anesthesia.
- Parental presence was varied during induction and emergence; behavior was monitored using standardized scales.
Main Results:
- No significant difference in emergence distress was found between groups with or without parental presence during emergence.
- Children exhibiting clingy behavior or frequent temper tantrums were more prone to emergence distress.
Conclusions:
- Parental presence during emergence did not mitigate distress.
- Pre-existing child temperament factors, such as separation anxiety and a history of tantrums, are associated with emergence distress.
Background:
Emergence distress commonly occurs in children recovering from the immediate effects of general anaesthesia. This study was performed to (1) examine whether parental presence in the operating room during emergence from anaesthesia reduces the incidence or severity of emergence distress behaviour, and (2) assess psychosocial risk factors, including child temperament and sleep behaviour, for development of emergence distress.
Methods:
A randomized and controlled trial of parental presence at emergence was conducted in 100 ASA class I and II children having general anaesthesia for inguinal or penile surgery. Children in the study group had a parent present at induction and emergence of anaesthesia, while children in the control group had a parent present only at induction. Emergence and postanaesthesia care unit (PACU) behaviour was monitored using both the Operating Room Behaviour Rating Scale (ORBRS) and a 7-point Likert type cooperation scale.
Results:
One-way anovas showed no significant differences between the control group and the study group on emergence distress behaviour. The frequency of negative postoperative behavioural changes at 1 and 4 weeks postsurgery was low in both groups. Children described as clingy/dependent (chi2 = 5.57, P < 0.06) and children with frequent temper tantrums (chi2 = 7.44, P < 0.02) were more likely to have emergence distress behaviour.
Conclusions:
Parental presence during emergence from anesthesia did not decrease the incidence or severity of emergence distress behaviour in children. Young children and children with a history of temper tantrums or separation anxiety may be more likely to develop such behaviour.
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