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Observational Study
. 2021 Oct;31(10):1056-1064.
doi: 10.1111/pan.14259. Epub 2021 Aug 6.

Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: A prospective observational study

Jonghae Kim  1 , Sung Hye Byun  2 , Jun Won Kim  3 , Ji-Yoon Kim  4 , Yun Jin Kim  5 , Nayeon Choi  5 , Bong Soo Lee  4 , Seungcheol Yu  4 , Eugene Kim  6
Affiliations
Observational Study

Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: A prospective observational study

Jonghae Kim et al. Paediatr Anaesth. 2021 Oct.

Abstract

Background: Emergence delirium is well known as early postoperative behavioral change after general anesthesia. However, it is unclear whether children with emergence delirium have negative behavioral changes after hospital discharge.

Aim: This observational study investigated the association between emergence delirium and posthospital behavioral changes.

Methods: One-hundred preschoolers aged 2-7 years undergoing elective surgery were enrolled in 2 tertiary university hospitals. Preoperative anxiety level was assessed using modified Yale preoperative anxiety scale. Emergence delirium was defined via pediatric anesthesia emergence delirium score ≥12 at any time in the recovery room. We divided the delirium score into a delirium-specific score (the sum of the first 3 items: eye contact, purposeful movement, and awareness of surrounding) and a pain-related score (the sum of the last 2 items: restlessness and inconsolability). High delirium scores represent severe emergence delirium. Posthospital behavioral changes were assessed by a change in Child Behavior Checklist 1.5-5 scores before and 1 week after surgery. The primary outcome was the total behavior checklist scores 1 week after surgery. Multiple linear regression was performed to identify risk factors for posthospital behavioral changes.

Results: Children with emergence delirium (n = 58) had higher postoperative behavior checklist scores than children without emergence delirium (n = 42) [mean (SD), 22.8 (17.5) vs. 14.0 (12.1); mean difference (95% CI), 8.8 (1.5-16.2)]. Increases in preoperative anxiety level [regression coefficient (b) (95% CI) =0.241 (0.126-0.356)] and peak delirium-specific score [b = 0.789 (0.137-1.442)] were associated with an increase in behavior checklist score 1 week after surgery, while pain-related score, type of surgery, premedication, and age were not.

Conclusion: Children with emergence delirium developed more severe behavior changes 1 week after surgery than those without emergence delirium. High preoperative anxiety level and emergence delirium scores were associated with posthospital behavioral changes.

Keywords: child behavior checklist; emergence delirium; general anesthesia; posthospital change; preoperative anxiety; preschool children.

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References

REFERENCES

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