Observational study of perioperative behavior changes in children having teeth extracted under general anesthesia
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Published on: June 10, 2013
Richard M Beringer1, Philip Segar, Annabel Pearson
1Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK.
Insights
Perioperative behavioral changes are common in children undergoing anesthesia. Previous trauma, male sex, and induction distress increase risk for these negative behaviors.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Healthcare Management
Background:
- Perioperative behavioral disturbance is a frequent issue in pediatric patients.
- Negative behavior changes can occur during anesthesia induction, recovery, and post-discharge.
- Limited research exists on this topic within the UK.
Purpose of the Study:
- To determine the incidence of behavioral changes in children undergoing anesthesia.
- To identify specific risk factors associated with increased behavioral disturbances.
- To inform strategies for managing at-risk children.
Main Methods:
- Prospective observational study of 102 healthy children (2-12 years) undergoing elective dental extractions.
- Assessed anxiety, behavior during induction, emergence delirium (using the Pediatric Anesthesia Emergence Delirium [PAED] scale), and post-hospitalization behavior.
- Analyzed data for associations between pre-existing factors and behavioral outcomes.
Main Results:
- 52% of children showed behavioral changes on postoperative day 1, decreasing to 22% on day 7.
- High anxiety during induction was observed in 67% of children.
- Risk factors identified include prior traumatic healthcare experiences, male sex, and distress during anesthesia induction.
Conclusions:
- Perioperative behavioral disturbance is prevalent in pediatric anesthesia patients.
- Identifying at-risk children is crucial for proactive management.
- Adapting care strategies can help minimize adverse behavioral outcomes.
Background:
Perioperative behavioral disturbance is common in children. Negative behavior changes may be seen during induction of anesthesia, during recovery and following discharge home. There has been little research on this subject in the UK.
Objectives:
The aim of this study was to determine the incidence of behavioral changes within our institution and identify which children are at increased risk.
Methods:
A prospective observational study of healthy children aged two to 12 undergoing elective dental extractions under general anesthesia. Assessments included: the child's and parent's state anxiety; anxiety and behavior during induction of anesthesia (modified Yale preoperative anxiety scale and the pediatric anesthesia behavior score); behavior in PACU (pediatric anesthesia emergence delirium [PAED] scale); behavior at home on postoperative days 1 and 7 (post hospitalization behavior questionnaire). Data were examined for associations and correlations.
Results:
One hundred and two children with a median age of 6 years were recruited. Sixty-seven per cent exhibited high anxiety during induction of anesthesia, although only 3% demonstrated significant vocal or physical resistance. Thirteen per cent had a PAED score of 10 or more. Post-hospitalization behavior changes were demonstrated by 52% of children on day 1 and 22% on day 7; and were associated with: a previous traumatic healthcare experience, male sex, and distress during induction of anesthesia.
Conclusions:
Perioperative behavioral disturbance is common in children undergoing anesthesia. Predicting which children are at increased risk may allow us to adapt the management of these children in order to minimize adverse behavior changes.
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