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Pediatric emergence delirium is linked to increased early postoperative negative behavior within two weeks after
Anne Houben1, Shahab Ghamari2, Andreas Fischer3
1Klinikum Dortmund, Department of Anesthesiology and Operative Intensive Care Medicine, Dortmund, Germany.
Insights
Pediatric emergence delirium after adenoidectomy is common and linked to negative behaviors like sleep disturbance and separation anxiety. Parents should be aware of potential behavioral changes post-surgery.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Surgery
- Child Psychology
Background:
- Observational study on pediatric adenoidectomy outcomes.
- Focus on emergence delirium and postoperative behavior.
- Investigated preschool children undergoing outpatient procedures.
Purpose of the Study:
- Measure incidence of pediatric emergence delirium.
- Investigate early postoperative negative behavior.
- Correlate delirium with subsequent behavioral changes.
Main Methods:
- Prospective, multicenter study of 222 preschool children.
- Multimodal anesthesia with propofol, remifentanil, and adjuncts.
- Assessed emergence delirium via Pediatric Anesthesia Emergence Delirium Scale (PAED) and behavior via post-hospitalization questionnaire.
Main Results:
- Emergence delirium incidence was 23%.
- Postoperative negative behavior was significantly higher in children with emergence delirium (24% vs. 11%).
- Sleep disturbance and separation anxiety were the most common behavioral issues.
Conclusions:
- Emergence delirium is associated with early postoperative negative behavior up to two weeks post-adenoidectomy.
- Parents of children experiencing delirium should anticipate potential behavioral changes.
- Approximately 1 in 4 children with emergence delirium may exhibit negative behaviors.
Background:
The aim of this prospective multicenter observational study was to measure the incidence of postoperative pediatric emergence delirium and to investigate the occurrence of early postoperative negative behavior within two weeks after outpatient adenoidectomy in preschool children.
Methods:
The study comprised 222 patients (1...7 years of age). All children received a multimodal anesthesia based on total intravenous anesthesia with propofol and remifentanil in combination with piritramid (0.1 mg.kg-1), ibuprofen (10 mg.kg-1), dexamethason (0.15 mg.kg-1), and ketanest S (0.1 mg.kg-1). We evaluated emergence delirium using the Pediatric Anesthesia Emergence Delirium Scale (PAED) at different predefined time points during the recovery period. Emergence delirium was defined as a PAED score ... 9 for the first three criteria. Additionally, we defined early postoperative negative behavior to be present when at least 5 of 27 criteria of the post hospitalization behavior questionnaire were positive.
Results:
The incidence of emergence delirium following our anesthetic regime was 23%. The incidence of early postoperative negative behavior was significantly higher among patients with emergence delirium (24% vs. 11%, p = 0.04). The two categories, ..úsleep disturbance..Ñ and ..úseparation anxiety..Ñ, tested within the questionnaire for early postoperative negative behavior, were identified as the most common postoperative negative behavioral changes.
Conclusion:
Emergence delirium not only plays a role immediately after surgery but is also linked to early postoperative negative behavior within two weeks after outpatient adenoidectomy. Parents should be informed that early postoperative negative behavior may occur in 1 out of 4 patients if emergence delirium was present postoperatively.
Trial Registration:
DRKS ... German Clinical Trial Register ID: DRKS00013121.
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