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Does dexmedetomidine given as a premedication or intraoperatively reduce post-hospitalisation behaviour change in
Paul Lee-Archer1,2,3, Craig McBride4, Rebecca Paterson2
1Department of Anaesthesia, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.
Insights
This study investigates dexmedetomidine's effect on post-hospitalisation behaviour change (PHBC) in children after general anaesthesia. It aims to determine if dexmedetomidine reduces anxiety-related behaviours following surgery.
Area of Science:
- Pediatric Anesthesiology
- Behavioral Science
- Pharmacology
Background:
- Post-hospitalisation behaviour change (PHBC) affects over 50% of children after general anaesthesia, with symptoms like sleep disturbances and tantrums.
- While typically short-lived, PHBC can persist for up to 12 months in 5-10% of children.
- Risk factors include pre-existing anxiety, prior negative hospital experiences, emergence delirium, and preschool age.
Purpose of the Study:
- To evaluate the efficacy of dexmedetomidine in mitigating post-hospitalisation behaviour change (PHBC) in children undergoing general anaesthesia.
- To assess the impact of dexmedetomidine, administered pre-operatively or intra-operatively, on children's behaviour post-surgery.
- To explore the relationship between parental anxiety, child's anxiety during anaesthesia induction, and subsequent PHBC.
Main Methods:
- A randomized controlled trial involving children aged 2-7 years undergoing day-case procedures under general anaesthesia.
- Participants will be assigned to three groups: dexmedetomidine pre-medication, intra-operative dexmedetomidine, or a control group.
- Parental and child anxiety levels will be measured using validated tools. Post-operative behaviours will be assessed using the Post Hospitalisation Behaviour Questionnaire and Strengths and Difficulties Questionnaire at 3, 14, and 28 days.
Main Results:
- Data collection and analysis are ongoing; results are pending.
- The study is registered with ANZCTR (12616000096459).
- No preliminary results are available at this pre-results stage.
Conclusions:
- The study aims to provide evidence on dexmedetomidine's role in managing PHBC, potentially offering a new strategy for improving pediatric post-surgical recovery.
- Findings could inform clinical practice regarding the use of dexmedetomidine to reduce negative behavioural sequelae in children post-anaesthesia.
- Further research is needed to confirm the long-term effectiveness and safety of dexmedetomidine for PHBC prevention.
Introduction:
It has been reported that post-hospitalisation behaviour change (PHBC) occurs in over 50% of children undergoing a general anaesthetic and manifests as behaviours such as sleep and eating disorders, defiance of authority, nightmares, enuresis and temper tantrums. The effect is usually short-lived (2-4 weeks); however, in 5-10% of children, these behaviours can last up to 12 months. The risk factors for developing PHBC include underlying anxiety in the child or parent, a previous bad hospital experience, emergence delirium and preschool age. A recent meta-analysis of alpha-2 agonists (including dexmedetomidine) found that they effectively reduce the incidence of emergence delirium but none of the studies looked at longer term outcomes, such as PHBC.
Methods And Analysis:
Two-year-old to seven-year-old children requiring general anaesthesia for common day-case procedures will be randomly assigned to one of three groups: a dexmedetomidine pre medication group, an intraoperative dexmedetomidine group and a control group. Baseline anxiety levels of the parent will be recorded and the anxiety of the child during induction of anaesthesia will also be recorded using validated tools. The primary outcome will be negative behaviours after hospitalisation and these will be measured using the Post Hospitalisation Behaviour Questionnaire for Ambulatory Surgery and the Strengths and Difficulties Questionnaire. These questionnaires will be administered by a blinded researcher at days 3, 14 and 28 post surgery.
Ethics And Dissemination:
Ethics approval has been granted by the Children's Health Queensland human research ethics committee (HREC/15/QRCH/248) and the University of Queensland human research ethics office (#2016001715). Any amendments to this protocol will be submitted to the ethics committees for approval.
Trial Registration Number:
ANZCTR:12616000096459; Pre-results.
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