Assessment of risk factors for emergence distress and postoperative behavioural changes in children following general anaesthesia.
BACKGROUND
Emergence distress commonly occurs in children recovering from the immediate effects of general anaesthesia. This study was performed to (1) examine whether parental presence in the operating room during emergence from anaesthesia reduces the incidence or severity of emergence distress behaviour, and (2) assess psychosocial risk factors, including child temperament and sleep behaviour, for development of emergence distress.


METHODS
A randomized and controlled trial of parental presence at emergence was conducted in 100 ASA class I and II children having general anaesthesia for inguinal or penile surgery. Children in the study group had a parent present at induction and emergence of anaesthesia, while children in the control group had a parent present only at induction. Emergence and postanaesthesia care unit (PACU) behaviour was monitored using both the Operating Room Behaviour Rating Scale (ORBRS) and a 7-point Likert type cooperation scale.


RESULTS
One-way anovas showed no significant differences between the control group and the study group on emergence distress behaviour. The frequency of negative postoperative behavioural changes at 1 and 4 weeks postsurgery was low in both groups. Children described as clingy/dependent (chi2 = 5.57, P < 0.06) and children with frequent temper tantrums (chi2 = 7.44, P < 0.02) were more likely to have emergence distress behaviour.


CONCLUSIONS
Parental presence during emergence from anesthesia did not decrease the incidence or severity of emergence distress behaviour in children. Young children and children with a history of temper tantrums or separation anxiety may be more likely to develop such behaviour.
Department of Anesthesiology, University Hospitals of Cleveland, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. paul.tripi@uhhs.com
Paul A
PA
Tripi
Tonya Mizell
TM
Palermo
Susan
S
Thomas
Mark M
MM
Goldfinger
Ivan
I
Florentino-Pineda
D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D002666:Psychology, Child