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Eur J Pediatr Surg 2024; 34(04): 368-373
DOI: 10.1055/a-2128-0974
Original Article

Parental Presence during Induction of Anesthesia and Emergence Delirium Influence the Incidence of Postoperative Maladaptive Behavioral Changes

Diego Gil Mayo 
1   Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
,
Pascual Sanabria Carretero
2   Department of Pediatric Anesthesiology, Hospital Universitario La Paz and H. Quironsalud, Madrid, Spain
,
Luis Gajate Martin
1   Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
,
Jose Alonso Calderón
3   Department of Pediatric Surgery, Hospital Universitario Niño Jesús and H. Quironsalud, Madrid, Spain
,
Maria Gomez Rojo
1   Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
,
Francisco Hernández Oliveros
4   Department of Pediatric Surgery, Hospital Universitario La Paz and H. Quironsalud, Madrid, Spain
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Abstract

Objective Surgical intervention in pediatric patients can cause variable degrees of psychological stress with potential consequences in the perioperative period and even in the long term, after hospital discharge in the form of behavioral changes days and months later. The aim of our study was to determine which preoperative preparation strategy reduces postoperative maladaptive behavioral changes in children undergoing ambulatory pediatric surgery.

Materials and Methods This prospective observational study included 638 pediatric American Society of Anesthesiologists physical status I or II patients who underwent ambulatory pediatric surgery. They were grouped into four preoperative preparation groups: not premedicated (NADA), premedicated with midazolam (MDZ), parental presence during induction of anesthesia (PPIA), and parental presence during induction of anesthesia and premedicated with midazolam (PPIA + MDZ). All patients included in the study were contacted by telephone during 1 year posthospital discharge to assess the postoperative maladaptive behavioral changes using the Posthospitalization Behavior Questionnaire (PHBQ). We performed a multivariate analysis to evaluate the influence of type of preparation and behavioral changes.

Results Patients in the PPIA and PPIA + MDZ preparation groups presented less postoperative maladaptive behavioral changes compared to patients in the NADA and MDZ groups (odds ratio [OR]: 1.8 [1.1–2.8] and OR 2.2 [1.03–4.49]) during the first week and first month. The intensity of emergence delirium measured by the Pediatric Anesthesia Emergence Delirium (PAED) scale increases the probability of postoperative maladaptive behavioral changes (OR: 1.05 [1.006–1.103]).

Conclusion The presence of parents during induction of anesthesia (PPIA and PPIA + MDZ) is a very effective strategy in reducing postoperative behavioral changes. These benefits are more significant in children under 5 years of age.

Keywords

parental presence during induction of anesthesia - emergence delirium - postoperative maladaptive behavioral changes

Supplementary Material



Publication History

Received: 19 April 2023

Accepted: 10 July 2023

Accepted Manuscript online:
12 July 2023

Article published online:
08 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg 1999; 88 (05) 1042-1047
    PubMedGoogle Scholar
  • 2 Gil Mayo D, Sanabria Carretero P, Gajate Martin L, Alonso Calderón J, Hernández Oliveros F, Gomez Rojo M. Parental presence during induction of anesthesia improves compliance of the child and reduces emergence delirium. Eur J Pediatr Surg 2022; 32 (04) 346-351
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Vernon 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 (06) 581-593
    CrossrefPubMedGoogle Scholar
  • 4 Kain ZN, Mayes LC, O'Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med 1996; 150 (12) 1238-1245
    CrossrefPubMedGoogle Scholar
  • 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 (06) 1625-1630
    CrossrefPubMedGoogle Scholar
  • 6 Fortier MA, del Rosario AM, Rosenbaum A, Kain ZN. Beyond pain: predictors of postoperative maladaptive behavior change in children. Paediatr Anaesth 2010; 20 (05) 383-477
    CrossrefPubMedGoogle Scholar
  • 7 Yuki K, Daaboul DG. Postoperative maladaptive behavioral changes in children. Middle East J Anaesthesiol 2011; 21 (02) 183-189
    PubMedGoogle Scholar
  • 8 Karling M, Stenlund H, Hägglöf B. Behavioural changes after anaesthesia: validity and liability of the post hospitalization behavior questionnaire in a Swedish paediatric population. Acta Paediatr 2006; 95 (03) 340-346
    CrossrefPubMedGoogle Scholar
  • 9 Rasti-Emad-Abadi R, Naboureh A, Nasiri M, Motamed N, Jahanpour F. The effects of preanesthetic parental presence on preoperative anxiety of children and their parents: a randomized clinical trial study in Iran. Iran J Nurs Midwifery Res 2017; 22 (01) 72-77
    CrossrefPubMedGoogle Scholar
  • 10 Kain ZN, MacLaren J, McClain BC. et al. Effects of age and emotionality on the effectiveness of midazolam administered preoperatively to children. Anesthesiology 2007; 107 (04) 545-552
    CrossrefPubMedGoogle Scholar
  • 11 Sun LS, Li G, Miller TL. et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA 2016; 315 (21) 2312-2320
    CrossrefPubMedGoogle Scholar
  • 12 Romero K, Ruíz F. El trastorno de estrés postraumático en niños preescolares: una revisión literaria. Katharsis 2015; 20: 145-168
    CrossrefPubMedGoogle Scholar