Association between family environment and emergence delirium in pediatric patients after tonsillectomy and adenoidectomy: an observational prospective study
Associação entre ambiente familiar e delírio do despertar em pacientes pediátricos após tonsilectomia e adenoidectomia: um estudo observacional prospectivo
Yubo Gao, Huihui Pei, Zhendong Liu, Yunfeng Bai, Jun Liu, Xinli Ni
Abstract
Background
Preoperative anxiety in children is a known risk factor for Emergence Delirium (ED). The family environment may indirectly influence ED by modulating anxiety levels, but its direct role in ED remains unclear. The purpose of this study is to explore the associations between the occurrence of ED and family environmental factors in children. Identifying such associations may support the use of preoperative screening and targeted interventions to reduce ED risk.
Methods
In this prospective observational study, 334 children (3~7 years) undergoing elective tonsillectomy/adenoidectomy were assessed. Preoperative visits recorded clinical data and used the Chinese Family Environment Scale (FES-CV) and State/Trait Anxiety Inventories (parental anxiety). Preoperative child anxiety was measured via modified Yale Preoperative Anxiety Scale (m-YPAS). ED was assessed postoperatively in PACU using the Pediatric Anesthesia Emergence Delirium scale (PAED ≥ 10).
Results
ED incidence was 21.9%. No significant association existed between overall home environment and ED. However, achievement orientation (FES-CV) negatively correlated with the m-YPAS score (m-YPAS; r = -0.139, p = 0.011). Independent ED risk factors identified: younger age (OR = 0.949, 95% CI 0.912~0.988), introverted personality (OR = 0.393, 95% CI 0.184~0.843), and higher postoperative pain (FLACC score; OR = 1.885, 95% CI 1.610~2.208).
Conclusion
While no direct link between home environment and ED was found, the negative correlation between achievement orientation and preoperative anxiety suggests an indirect influence. Identifying high-risk children using factors like age, personality, and pain levels remains important for ED prevention.
Keywords
Resumo
Introdução
A ansiedade pré-operatória em crianças é um fator de risco conhecido para o delírio ao despertar (ED). O ambiente familiar pode influenciar indiretamente o ED modulando os níveis de ansiedade, mas seu papel direto no ED ainda não está claro. O objetivo deste estudo é explorar as associações entre a ocorrência de ED e fatores do ambiente familiar em crianças. Identificar essas associações pode apoiar o uso de triagem pré-operatória e intervenções direcionadas para reduzir o risco de ED.
Métodos
Neste estudo observacional prospectivo, 334 crianças (3 a 7 anos) submetidas à tonsilectomia/adenoidectomia eletiva foram avaliadas. Durante a visita pré-operatória, foram registrados dados clínicos e aplicados a Chinese Family Environment Scale (FES-CV) e os State/Trait Anxiety Inventories (ansiedade parental). A ansiedade pré-operatória das crianças foi medida por meio da modified Yale Preoperative Anxiety Scale (m-YPAS). O ED foi avaliado de modo pós-operatório na Sala de Recuperação Pós-Anestésica (PACU) utilizando a Pediatric Anesthesia Emergence Delirium scale (PAED ≥ 10).
Resultados
A incidência de ED foi de 21,9%. Não houve associação significativa entre o ambiente familiar geral e ED. No entanto, a orientação para realização (achievement orientation, FES-CV) apresentou correlação negativa com o escore m-YPAS (m-YPAS; r = -0,139, p = 0,011). Fatores de risco independentes para ED identificados foram: idade menor (OR = 0,949, IC 95% 0,912–0,988), personalidade introvertida (OR = 0,393, IC 95% 0,184–0,843) e maior dor pós-operatória (escore FLACC; OR = 1,885, IC 95% 1,610–2,208).
Conclusão
Embora não tenha sido encontrada relação direta entre ambiente familiar e ED, a correlação negativa entre orientação para realização e ansiedade pré-operatória sugere uma influência indireta. A identificação de crianças de alto risco, considerando fatores como idade, personalidade e níveis de dor, continua sendo importante para a prevenção do ED.
Palavras-chave
Referencias
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Submitted date:
03/04/2025
Accepted date:
19/08/2025
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