Beyond pain: predictors of postoperative maladaptive behavior change in children

Fortier, Michelle A.; Rosario, Antonio M. Del; Rosenbaum, Abraham; Kain, Zeev N.

doi:10.1111/j.1460-9592.2010.03281.x

Cited by 76 publications

(99 citation statements)

References 37 publications

(47 reference statements)

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“…The effects of anesthetic neurotoxicity are also unlikely to manifest immediately, while post-operative maladaptive behaviors, which are present in one third of children 2 weeks after surgery, may resemble a variety of different mental disorders. (28) In order to avoid capturing pre-existing diagnoses and cases of transient post-operative maladaptive behaviors, as well as reduce ascertainment bias due to increased medical visits in children immediately after surgery, a latency period of at least 6 months was imposed on the definition of anesthetic related incident mental disorders. Therefore, all exposed children with a mental disorder diagnosed prior to surgery, or in the first 6 months after the surgical procedure were excluded from analysis.…”

Section: Methodsmentioning

confidence: 99%

Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis

Ing¹,

Sun

Olfson

et al. 2017

Anesthesia &Amp; Analgesia

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Introduction Animals exposed to anesthetics during specific age periods of brain development experience neurotoxicity, with neurodevelopmental changes subsequently observed during adulthood. The corresponding vulnerable age in children however is unknown. Methods An observational cohort study was performed using a longitudinal dataset constructed by linking individual-level Medicaid claims from Texas and New York from 1999 to 2010. This dataset was evaluated to determine whether the timing of exposure to anesthesia under age 5 years for a single common procedure (pyloromyotomy, inguinal hernia, circumcision outside the perinatal period, or tonsillectomy and/or adenoidectomy) is associated with increased subsequent risk of diagnoses for any mental disorder, or specifically developmental delay (DD) such as reading and language disorders, and attention deficit hyperactivity disorder (ADHD). Exposure to anesthesia and surgery was evaluated in 11 separate age at exposure categories: ≤28 days old, >28 days and ≤6 months, >6 months and ≤1 year, and 6 month age intervals between >1 year old and ≤5 years old. For each exposed child, five children matched on propensity score calculated using sociodemographic and clinical covariates were selected for comparison. Cox proportional hazards models were used to measure the hazard ratio of a mental disorder diagnosis associated with exposure to surgery and anesthesia. Results A total of 38,493 children with a single exposure and 192,465 propensity score matched children unexposed before age 5 were included in the analysis. Increased risk of mental disorder diagnosis was observed at all ages at exposure with an overall hazard ratio of 1.26 (95% confidence interval [CI], 1.22–1.30), which did not vary significantly with the timing of exposure. Analysis of DD and ADHD showed similar results, with elevated hazard ratios distributed evenly across all ages, and overall hazard ratios of 1.26 (95% CI, 1.20–1.32) for DD and 1.31 (95% CI, 1.25–1.37) for ADHD. Conclusions Children who undergo minor surgery requiring anesthesia under age 5 have a small but statistically significant increased risk of mental disorder diagnoses, and DD and ADHD diagnoses, but the timing of the surgical procedure does not alter the elevated risks. Based on these findings, there is little support for the concept of delaying a minor procedure to reduce long-term neurodevelopmental risks of anesthesia in children. In evaluating the influence of age at exposure, the types of procedures included may need to be considered, as some procedures are associated with specific comorbid conditions and are only performed at certain ages.

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Section: Methodsmentioning

confidence: 99%

Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis

Ing¹,

Sun

Olfson

et al. 2017

Anesthesia &Amp; Analgesia

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“…In addition, high doses of opioids may cause undesirable adverse effects, such as respiratory depression, oxygen desaturation, nausea, vomiting, and postoperative negative behavioral changes (PNCs). [2][3][4] Thoracic paravertebral block (TPVB) is used as an alternative method to epidural anesthesia/analgesia to provide postoperative analgesia for thoracic surgery in adults. [5][6][7] The mechanism of action of paravertebral block involves local anesthetic (LA) penetration into the spinal nerve to produce an afferent sensory blockade.…”

mentioning

confidence: 99%

A Prospective Randomized Observer-Blinded Study to Assess Postoperative Analgesia Provided by an Ultrasound-Guided Bilateral Thoracic Paravertebral Block for Children Undergoing the Nuss Procedure

Gurnaney

et al. 2014

Regional Anesthesia and Pain Medicine

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“…In genitourinary surgery, that number was even higher. 19 Fortier et al 20 found 81% of children with NPOBC at POD 1, and about 35% in the second week. These results seem comparable with the results of our study.…”

Section: Discussionmentioning

confidence: 97%

“…They include potential interactions between preoperative (anxiety of child and parents, a child's temper, preparation for surgery), intraoperative (anaesthesia induction technique, selection of anaesthetic drugs) and postoperative factors (ED, pain, unfamiliar hospital environment). 20,[23][24][25] Initial research by Kain et al 1 found no correlation between pain and NPOBC. In contrast, pain mainly after hospitalisation is one of the biggest risk factors for the occurrence of behaviour changes after surgery.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Are postoperative behavioural changes after adenotonsillectomy in children influenced by the type of anaesthesia?

Stipić

Carev

Kardum

et al. 2015

European Journal of Anaesthesiology

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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.

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Beyond pain: predictors of postoperative maladaptive behavior change in children

Abstract: Individual child factors above and beyond pain predict maladaptive postoperative behavior change; identification of these predictors may be helpful in both preventing and ameliorating difficulties with behavioral recovery following surgery.

Cited by 76 publications

References 37 publications

Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis

Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis

A Prospective Randomized Observer-Blinded Study to Assess Postoperative Analgesia Provided by an Ultrasound-Guided Bilateral Thoracic Paravertebral Block for Children Undergoing the Nuss Procedure

Are postoperative behavioural changes after adenotonsillectomy in children influenced by the type of anaesthesia?

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