Preoperative Anxiety and Emergence Delirium and Postoperative Maladaptive Behaviors

Abstract

Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

Preoperative Oral Sedation with Midazolam and Paracetamol vs Sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

“…Children with preoperative anxiety are more likely to exhibit signs of emergence delirium and to develop behavioral changes in the postoperative periods [3] [4]. These children also present with postoperative pain and require strict pain control [2].…”

Comparative study of emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture

“…Lepouse et al (2006) reported that preoperative anxiety was a risk factor for emergence agitation, and in the research of Kain et al (2004), preoperative anxiety was related to delirium or changes in behavior after surgery.…”

Agitação no despertar da anestesia em crianças: aspectos atuais

“…A study of 791 children demonstrated that the risk of emergence agitation symptoms appearing increases by 10% for each increase of 10 points on the preoperative anxiety assessment score. 14 Although countless studies have assessed the effect of parents being present on the quality of anesthetic induction, there is no consensus in the literature on whether this is an independent causal factor of the occurrence of postoperative agitation or merely a bias. No relationship was observed between psychosocial and behavioral factors when these were compared in terms of postoperative agitation.…”