Related Experiment Video
Updated: Apr 28, 2026
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Are postoperative behavioural changes after adenotonsillectomy in children influenced by the type of anaesthesia?: A
Sanda Stojanovic Stipic1, Mladen Carev, Goran Kardum
1From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Split, Split, Croatia (SSS, MC, NE, DML), the Faculty of Philosophy, University of Split (GK), and the Department of ENT Surgery, University Hospital Split, Split, Croatia (ZR).
Insights
Total intravenous anesthesia (TIVA) reduced negative postoperative behavioral changes (NPOBCs) in children after adenotonsillectomy compared to sevoflurane. TIVA led to fewer and less severe behavioral issues, particularly anxiety and withdrawal.
Area of Science:
- Pediatric Anesthesiology
- Behavioral Psychology
- Surgical Outcomes
Background:
- Negative postoperative behavioral changes (NPOBCs) are common in children following surgery and general anesthesia.
- Persistent NPOBCs can significantly impact a child's emotional and cognitive development.
Purpose of the Study:
- To evaluate if different anesthetic techniques for adenotonsillectomy affect the incidence of NPOBCs.
- To compare sevoflurane (S) versus total intravenous anesthesia (TIVA) regarding NPOBCs.
Main Methods:
- A randomized controlled trial involving 64 children (aged 6-12) undergoing adenotonsillectomy.
- Children were assigned to either sevoflurane or TIVA anesthesia groups.
- Postoperative behavior was assessed using the Post Hospitalization Behavior Questionnaire (PHBQ) at multiple time points.
Main Results:
- The prevalence of NPOBCs was high, reaching 80% on postoperative day 1.
- TIVA demonstrated a significantly lower incidence and number of NPOBCs compared to sevoflurane.
- TIVA showed the greatest benefit in reducing separation anxiety, general anxiety, and apathy/withdrawal.
Conclusions:
- Anesthetic technique significantly influences the incidence and type of NPOBCs in children after adenotonsillectomy.
- Sevoflurane anesthesia was associated with more frequent and prolonged NPOBCs than TIVA.
- TIVA appears to be a preferable anesthetic choice for minimizing behavioral disturbances post-adenotonsillectomy.
Background:
Negative postoperative behavioural changes (NPOBCs) are very frequent in children after surgery and general anaesthesia. If they persist, emotional and cognitive development may be affected significantly.
Objective:
To assess whether the choice of different anaesthetic techniques for adenotonsillectomy may impact upon the incidence of NPOBC in repeated measurements.
Design:
A randomised, controlled, parallel-group trial.
Setting:
University Hospital Split, Croatia.
Patients:
Sixty-four children (aged 6 to 12 years, ASA 1 to 2) undergoing adenotonsillectomy assigned into one of two groups: sevoflurane (S) (n = 32) or total intravenous anaesthesia (TIVA) (n = 32).
Interventions:
Permuted-block randomisation with random block sizes of 4, 6 and 8, administering anaesthesia, and evaluation of NPOBC with the Post Hospitalization Behavior Questionnaire (PHBQ: 27 items describing six subscales). The PHBQ was filled out by parents at postoperative days (POD) 1, 3, 7 and 14, and 6 months after surgery.
Main Outcome Measures:
Differences in numbers of NPOBCs between two anaesthesia techniques, and NPOBC analysis by subscales.
Results:
The prevalence of at least one NPOBC after surgery ranged from a maximum of 80% [95% confidence interval (CI) 71 to 90%] on POD 1 to a minimum of 43% (95% CI 31 to 56%) 6 months after surgery. Absolute risk reduction for at least one NPOBC in the TIVA group compared with the S group increased from 0.24 on POD 1 to 0.55 6 months after surgery. The number of NPOBCs was also lower in the TIVA group [median 5, interquartile range (IQR) 2 to 10] than in the S group (median 22, IQR 10 to 32) (P < 0.001). The overall number of NPOBCs within PHBQ subscales was significantly lower in the TIVA group than in the S group. The largest difference in the number of NPOBCs between groups was observed for the separation anxiety subscale (mean 5, 95% CI 1 to 9; P < 0.001) followed by the general anxiety subscale (mean 4, 95% CI 3 to 5; P < 0.001) and apathy/withdrawal subscale (mean 3, 95% CI 1 to 5; P < 0.001).
Conclusion:
The prevalence of NPOBC after elective adenotonsillectomy in 6 to 12-year-old children was very high (80%). The choice of anaesthetic technique for adenotonsillectomy in children influenced the incidence and type of NPOBC. Sevoflurane/nitrous oxide anaesthesia was associated with more frequent and prolonged NPOBCs than TIVA, especially in the separation anxiety, general anxiety and withdrawal/apathy subscales.
Related Concept Videos
01:22Stages of General Anesthesia
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:26Tonsillitis II: Management
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:24Parenteral Anesthetics: Overview