The effect of dexmedetomidine on postoperative behaviour change in children: a randomised controlled trial

Abstract

Children may develop changes in their behaviour following general anaesthesia. Some examples of negative behaviour include temper tantrums and nightmares, as well as sleep and eating disorders. The aim of this study was to determine whether dexmedetomidine reduces the incidence of negative behaviour change after anaesthesia for day case surgery in children aged two to seven years. Children were randomly allocated to one of three groups: a premedication group received 2 mg.kg-1 intranasal dexmedetomidine; an intra-operative group received 1 mg.kg-1 intravenous dexmedetomidine; and a control group. The primary outcome was the incidence of negative behaviour on postoperative day 3 using the Post-Hospitalisation Behaviour Questionnaire for Ambulatory Surgery (PHBQ-AS) and the Strength and Difficulties Questionnaire (SDQ). Secondary outcomes included: the incidence of negative behaviour on postoperative days 14 and 28; anxiety at induction; emergence delirium; pain; length of recovery and hospital stay; and any adverse events. The data for 247 patients were analysed. Negative behaviour change on postoperative day 3 was similar between all three groups when measured with the PHBQ-AS (47%, 44% and 51% respectively; adjusted p=0.99) and the SDQ (median scores 7.5, 6.0 and 8.0 respectively; adjusted p=0.99). The incidence of negative behaviour in the group who received dexmedetomidine intra-operatively was less at postoperative day 28 (15% compared with 36% in the dexmedetomidine premedication group and 41% in the control group, p<0.001). We conclude that dexmedetomidine does not reduce the incidence of negative behaviour on postoperative day 3 in two to sevenyear olds having day case procedures.

Comparison of two measures of behavior change in children after day surgery

“…There was weak correlation between the PHBQ‐AS and the SDQ on day 3, moderate correlation on day 14, and weak‐to‐moderate correlation on day 28. These results are not as convincing as previously reported when the PHBQ‐AS was compared to the Functional Disability Inventory (Pearson's r = 0.49) 2 . One explanation for the poor correlation observed is that the SDQ has not been shown to have construct validity with respect to surgery.…”

“…The reliability results for the PHBQ‐AS in this study are in line with what has previously been reported. The original study describing the development of the PHBQ‐AS calculated a Cronbach's alpha of 0.80 based on results from a database of 1064 patients from the United States 2 . Our study found a Cronbach's alpha of 0.79 and split‐half correlation with Spearman Brown adjustment of 0.85.…”

“…The presence of negative behavior change was defined as a score greater than 3 on the PHBQ‐AS, as recommended by the authors, 2 and an increased risk of problem behavior was defined as a score greater than 12 on the SDQ, based on published guidelines for scoring the SDQ 4…”

“…The Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ‐AS) was developed to measure changes in behavior after pediatric day‐case procedure. It used a database of 1064 children with a mean age of 5.88 years pooled from multiple studies 2 ; however, it has not been extensively validated. This study compared the results of the PHBQ‐AS with a measure of child psychological adjustment, the Strength and Difficulties Questionnaire (SDQ), in a sample of 248 children aged between 2 and 7 years who underwent day surgery and anesthesia.…”

The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis

“…We evaluated the quality of the literature and selected high-quality literature as the inclusion criteria for research. [6][7][8][11][12][13]20,[26][27][28][29][30][31][32]…”