Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics

Abstract

This study analysed the frequency of distress at induction (DAI) in 2122 paediatric patients. The data were analysed to assess predictors of DAI and to examine associations between predictors of DAI and recovery characteristics. Patient age, preoperative behaviour, premedication (oral midazolam, n = 480) and venue for anaesthesia induction were associated with changes in the incidence of DAI. Distressed preoperative behaviour was a good predictor of DAI in all age groups. Premedication reduced the incidence of DAI in children aged 0.5-2 years old, and in older children who were distressed preoperatively. Induction in the Day Surgery Unit was associated with a reduction of the incidence of DAI in younger children. Children with DAI were more likely to suffer from distress at arousal (P = 0.001). Average early recovery time was prolonged 4.4 minutes and average discharge time in day patients was delayed 36 minutes by the use of oral midazolam premedication. Premedication was not significantly associated with arousal distress. We conclude that a policy of optimizing nonpharmacological approaches for minimizing induction distress, combined with selective premedication with oral midazolam, can produce a low incidence of induction distress and adverse effects.

The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

“…36 However, the children in this sample were not undergoing ordinary elective surgical procedures; instead they had been referred for this radical treatment on account of their poor dental condition, toothache and likely pre-existing dental anxiety. 6,37 The fact that the population in the present study had preoperative total Rutter scores approaching the previously validated indicator for clinically signifi cant 'disturbance' is evidence of their poor preoperative behavioural and emotional state.…”

Ansiedade, a criança e os pais

“…On the other hand, Kain et al 13 have shown that at operating center admission, children above 7 years of age are more anxious as compared to 4 to 7 years old children. However, some authors have found in an extensive study with children that anxiety during induction is not age-related 22 . Postoperative behavior changes seem to be more common in younger children 12,23 .…”

“…Por outro lado, Kain e col. 13 mostraram que, na entrada do centro cirúrgico, as crianças com mais de 7 anos de idade são mais ansiosas do que as da faixa etária de 4 a 7 anos. Entretanto, alguns autores encontraram em um extenso estudo em crianças, que a ansiedade durante a indução não variou com a idade 22 . No pós-operatório, alterações de comportamento parecem ocorrer com mais freqüência em crianças mais novas 12,23 .…”

Unkooperatives Kind bei Narkoseeinleitung

“…Studien zum Einfluss des Alters auf die Inzidenz von Angst bei Narkoseeinleitung haben widersprüchliche Resultate ergeben [2,5,6]. Negative postoperative Verhaltensänderungen scheinen bei jünge-ren Kindern häufiger zu sein (Vorschulalter, [4,7] …”