Preoperative Anxiety and Emergence Delirium and Postoperative Maladaptive Behaviors

Department of Pediatrics, Yale University, New Haven, Connecticut, United States
Anesthesia & Analgesia (Impact Factor: 3.47). 01/2005; 99(6):1648-54, table of contents. DOI: 10.1213/01.ANE.0000136471.36680.97
Source: PubMed


Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

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    • "Emergence delirium (ED) occurs in 20-80% of children, especially when sevoflurane is used for maintenance of anaesthesia.[10] A study by Kain et al. suggested that children with ED are 7 times more likely to develop behavioural changes.[11] Various techniques including administration of propofol, ketamine and lidocaine has been described to reduce ED. "
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    • "Therefore, concerns about emergence behaviors in children undergoing sevoflurane anesthesia remain, although sevoflurane is a useful pediatric anesthetic that does not irritate the airway and is associated with hemodynamic stability and rapid induction and emergence. Preoperative anxiety is one of the proposed contributing factors to EA [22]. Midazolam, a widely used anxiolytic agent, was investigated as a medication for preventing EA. "
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    Korean journal of anesthesiology 03/2013; 64(3):240-5. DOI:10.4097/kjae.2013.64.3.240
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    • "A limitation of this study is that we did not measure the patient's degree of anxiety before surgery. Lepouse et al. [5] reported that preoperative anxiety was a risk factor for emergence agitation, and in the research of Kain et al. [25], preoperative anxiety was related to delirium or changes in behavior after surgery. However, in our study we did not measure the degree of preoperative anxiety in the subjects. "
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    ABSTRACT: Emergence agitation is associated with increased morbidity and hospital costs. However, there have been few reports in the medical literature on the occurrence of emergence agitation in adults. The aim of this study was to compare emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. Forty adults (ASA I-II, 20-60 yr) undergoing closed reduction of nasal bone fracture were randomly assigned to either sevoflurane or propofol group and anesthesia was maintained with sevoflurane or propofol. The bispectral index (BIS) was monitored and maintained within 40-60. At the end of surgery, patients were transported to the post anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). Emergence agitation was defined as and AFPS score of 3 or 4. Pain score were measured by numeric rating scale (NRS) on arrival and peak value at PACU. Nine (45.0%) patients in the sevoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation in the PACU (P = 0.031). There was no correlation between peak NRS and Aono's four-point scale. Propofol may decrease incidence of emergence agitation compared to sevoflurane in adults undergoing closed reduction of nasal bone fracture.
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