Pediatric emergence delirium is linked to increased early postoperative negative behavior within two weeks after adenoidectomy: an observational study
O delirium pediátrico ao despertar está associado ao aumento do comportamento negativo no pós-operatório imediato dentro de duas semanas após a adenoidectomia: um estudo observacional
Anne Houben, Shahab Ghamari, Andreas Fischer, Claudia Neumann, Torsten Baehner, Richard K. Ellerkmann
Abstract
Background
The aim of this prospective multicenter observational study was to measure the incidence of postoperative pediatric emergence delirium and to investigate the occurrence of early postoperative negative behavior within two weeks after outpatient adenoidectomy in preschool children.
Methods
The study comprised 222 patients (1–7 years of age). All children received a multimodal anesthesia based on total intravenous anesthesia with propofol and remifentanil in combination with piritramid (0.1 mg.kg-1), ibuprofen (10 mg.kg-1), dexamethason (0.15 mg.kg-1) and ketanest S (0.1 mg.kg-1). We evaluated emergence delirium using the Pediatric Anesthesia Emergence Delirium Scale (PAED) at different predefined time points during the recovery period. Emergence delirium was defined as a PAED score ≥ 9 for the first three criteria. Additionally, we defined early postoperative negative behavior to be present when at least 5 of 27 criteria of the post hospitalization behavior questionnaire were positive.
Results
The incidence of emergence delirium following our anesthetic regime was 23%. The incidence of early postoperative negative behavior was significantly higher among patients with emergence delirium (24% vs. 11%,p = 0.04). The two categories, “sleep disturbance” and “separation anxiety”, tested within the questionnaire for early postoperative negative behavior were identified as the most common postoperative negative behavioral changes.
Conclusion
Emergence delirium not only plays a role immediately after surgery but is also linked to early postoperative negative behavior within two weeks after outpatient adenoidectomy. Parents should be informed that early postoperative negative behavior may occur in 1 out of 4 patients if emergence delirium was present postoperatively.
Keywords
Resumo
Introdução
O objetivo deste estudo observacional multicêntrico prospectivo foi medir a incidência de delírio do despertar pediátrico pós-operatório e investigar a ocorrência de comportamento negativo pós-operatório precoce dentro de duas semanas após adenoidectomia ambulatorial em crianças pré-escolares.
Métodos
O estudo incluiu 222 pacientes (1 a 7 anos de idade). Todas as crianças receberam anestesia multimodal baseada em anestesia venosa total com propofol e remifentanil em combinação com piritramida (0,1 mg.kg-1), ibuprofeno (10 mg.kg-1), dexametasona (0,15 mg.kg-1) e cetaneste S. (0,1 mg.kg-1). Avaliamos o delirium ao despertar usando a Escala de Delirium de Emergência em Anestesia Pediátrica (PAED) em diferentes momentos predefinidos durante o período de recuperação. Delirium do despertar foi definido como pontuação PAED ≥ 9 para os três primeiros critérios. Além disso, definimos que o comportamento negativo pós-operatório precoce estava presente quando pelo menos 5 dos 27 critérios do questionário de comportamento pós-hospitalização eram positivos.
Resultados
A incidência de delirium do despertar após nosso regime anestésico foi de 23%. A incidência de comportamento negativo pós-operatório precoce foi significativamente maior entre pacientes com delirium do despertar (24% vs. 11%, p = 0,04). As duas categorias, “distúrbios do sono” e “ansiedade de separação”, testadas no questionário para comportamento negativo no pós-operatório imediato, foram identificadas como as alterações comportamentais negativas no pós-operatório mais comuns.
Conclusão
O delirium do despertar não apenas desempenha um papel imediatamente após a cirurgia, mas também está ligado ao comportamento negativo no pós-operatório precoce dentro de duas semanas após a adenoidectomia ambulatorial. Os pais devem ser informados de que um comportamento negativo no pós-operatório precoce pode ocorrer em 1 em cada 4 pacientes se o delirium do despertar estiver presente no pós-operatório.
Palavras-chave
References
1. Costi D, Cyna AM, Ahmed S, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014:CD007084.
2. Mason KP. Paediatric emergence delirium: a comprehensive review and interpretation of the literature. Br J Anaesth. 2017;118:335–43.
3. Bortone L, Bertolizio G, Engelhardt T, Frawley G, Somaini M, Ingelmo PM. The effect of fentanyl and clonidine on early postoperative negative behavior in children: a double-blind placebo-controlled trial. Paediatr Anaesth. 2014;24:614–9.
4. Swart ED, Rajah C, Rodseth RN. Induction behavior and race and its association with postoperative agitation in paediatric elektive surgery. South African J Anaesth Analg. 2017;23:36–9.
5. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg. 2003;96:1625–30.
6. Aono J, Ueda W, Mamiya K, Manabe M, Takimoto E. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. 1997;87:1298–300.
7. Grundmann U, Uth M, Eichner A, Wilhelm W, Larsen R. Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desfluranenitrous oxide inhalation anaesthesia. Acta Anaesthesiol Scand. 1998;42:845–50.
8. Tan Y, Shi Y, Ding H, Kong X, Zhou H, Tian J. -Opioid agonists for preventing emergence agitation under sevoflurane anesthesia in children: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2016;26:139–50.
9. Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104:216–23.
10. Kanaya A, Kuratani N, Satoh D, Kurosawa S. Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials. J Anesth. 2014;28:4–11.
11. Sajedi P, Baghery K, Hagibabie E, Mehr AM. Prophylactic use of oral acetaminophen or iv dexamethasone and combination of them on prevention emergence agitation in pediatric after adenotonsillectomy. Int J Prev Med. 2014;5:721–7.
12. Sikitch N, Lerman J. Development, and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100:1138–45.
13. Locatelli BG, Ingelmo PM, Emre S, et al. Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale. Paediatr Anaesth. 2013;23:301–8.
14. Kain ZN, Mayes LC, O’Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996;150:1238–45.
15. Kain ZN, Caldwell-Andrews AA, Maranets I, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004;99:1648–54.
16. Kain ZN, Caldwell-Andrews AA, Mayes LC, et al. Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial. Anesthesiology. 2007;106:65–74.
17. Buehrer S, Klaghofer R, Weiss M, Schmitz A. Verhaltensauffälligkeiten von Kindern und Jugendlichen nach Narkose: Entwicklung einer deutschsprachigen Version des Post Hospitalization Behavior Questionnaire (Negative behavioral changes in children and adolescents after anesthesia: Development of a German language version of the Post Hospitalization Behavior Questionnaire). Anaesthesist. 2015;64:115–21.
18. Vennon DT, Schulman JL, Foley JM. Changes in children’s behavior after hospitalization. Some dimensions of response and their correlates. Am J Dis Child. 1966;111:581–93.
19. Pieters BJ, Penn E, Nicklaus P, Bruegger D, Mehta B, Weatherly R. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. Paediatr Anaesth. 2010;20:944–50.
20. Chandler JR, Myers D, Mehta D, et al. Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia. Paediatr Anaesth. 2013;23:309–15.
21. Faulk DJ, Twite MD, Zuk J, Pan Z, Wallen B, Friesen RH. Hypnotic depth and the incidence of emergence agitation and negative postoperative behavioral changes. Paediatr Anaesth. 2010;20:72–81.
Submitted date:
08/31/2020
Accepted date:
03/13/2021
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email