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Association of Preoperative Inflammatory Markers With Preoperative Anxiety and Emergence Agitation in Children
Nezahat Merve Ata Soylu1, Zehra Hatipoglu1, Ersel Gulec1
1Department of Anesthesiology and Reanimation, Faculty of Medicine, Cukurova University, Adana, Türkiye.
Insights
Systemic immune inflammatory index (SII) can help identify children at risk for preoperative anxiety and emergence agitation (EA). Elevated SII levels are linked to higher risks, aiding anesthesiologists in patient management.
Area of Science:
- Pediatric Anesthesiology
- Neuroinflammation
- Biomarkers
Background:
- Emergence agitation (EA) is a postoperative neurobehavioral complication linked to neuroinflammation.
- Preoperative anxiety is an acute stress response.
- Identifying risk factors for EA and preoperative anxiety in children is crucial.
Purpose of the Study:
- To investigate the relationship between hemogram-derived inflammatory markers and preoperative anxiety and EA in pediatric patients.
- To assess the predictive value of inflammatory markers for these conditions.
Main Methods:
- Prospective observational study of 350 pediatric patients (5-12 years).
- Assessment of preoperative anxiety using the Yale Preoperative Anxiety Scale.
- Evaluation of EA using the Pediatric Anesthesia Emergence Delirium scale.
- Analysis of hemogram parameters, including leukocyte, monocyte, neutrophil, and platelet counts, and derived ratios like SII.
Main Results:
- Children with EA showed higher leukocyte, monocyte, neutrophil, and platelet counts, and elevated SII.
- Younger age, higher postoperative pain, and elevated SII were independently associated with EA.
- Preoperative anxiety was linked to higher white blood cell counts, younger age, anxious parents, and elevated SII.
Conclusions:
- Hemogram-derived inflammatory markers, especially SII, can identify children at risk for preoperative anxiety and EA.
- SII may aid anesthesiologists in proactive patient risk stratification and intervention.
- Early identification can lead to preventive strategies, reducing EA incidence.
Introduction:
Emergence agitation (EA) is a postoperative neurobehavioral complication characterized by a transient disturbance in cognition and perception following anesthesia. Neuroinflammation is thought to play a central role in its pathophysiology. Preoperative anxiety is the "acute preoperative stress response." This study aimed to evaluate the relationship between hemogram-derived inflammatory markers and the development of preoperative anxiety and EA in pediatric patients.
Methods:
This prospective observational study included 350 pediatric patients aged 5-12 years with ASA grade I-II. Preoperative anxiety was assessed in the waiting room using the modified Yale Preoperative Anxiety Scale. Demographic and clinical data, anesthesia/surgical data, and hemogram parameters were recorded. EA was evaluated in the recovery room using the Pediatric Anesthesia Emergence Delirium scale. Pain was assessed at 0, 5, 10, 20, and 30 min using the FLACC scale in children < 7 years and the Visual Analog Scale in those ≥ 7 years.
Results:
Of the total 350 patients, 130 (37.1%) developed EA. Compared with those without EA, children with EA had significantly higher leukocyte, monocyte, neutrophil, and platelet counts (p = 0.018, 0.005, 0.001, and 0.001, respectively), lower lymphocyte counts (p = 0.042), and elevated monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammatory index (SII) (all p < 0.001). Regression analysis showed that younger age, higher postoperative pain scores, and elevated SII were independently associated with EA. Preoperative anxiety was observed in 103 children (29.4%). These patients had higher white blood cell counts (p = 0.026), and regression analysis identified that younger age, anxious parents, and elevated SII were independently associated with preoperative anxiety.
Conclusion:
Easily obtainable hemogram-derived inflammatory markers, particularly SII, may be useful for identifying children at increased risk of preoperative anxiety and EA in children. These findings suggest that SII may assist anesthesiologists in identifying high-risk patients and implementing preventive strategies to reduce the incidence of EA.
Trial Registration:
The study was registered at ClinicalTrials.gov (NCT06648122).