Perioperative anxiety and postoperative behavioural disturbances in children: comparison between induction techniques.
OBJECTIVE
This study was designed to determine if subhypnotic propofol reduces postoperative behavioural disturbances in children undergoing sevoflurane induction compared with intravenous propofol induction for elective adenoidectomy and tonsillectomy.


METHODS
Following Ethics Committee approval and parental informed consent, ASA I-II, 120 children (2-10 yr) were recruited. Parents were not allowed to accompany their child. Unpremedicated children were randomly allocated to groups receiving inhalation induction with sevoflurane, 2-2.5 mg kg-1 intravenous propofol induction or inhalation induction with sevoflurane followed by subhypnotic dose of propofol (1 mg kg-1). Anaesthesia was maintained with 2-4% sevoflurane, O2 and N2O. Anxiety on arrival to operating theatre, at anaesthesia induction and 30 min after emergence was assessed. Parents completed a state-trait anxiety inventory test preoperatively and a post hospitalization behaviour questionnaire a week later to assess children's postoperative behavioural disturbances. Kruskal-Wallis test, Wilcoxon signed rank sum test, Bonferroni's test, Paired t-test, t-test, Pearson and Spearman's rank correlation test, chi2-test were used for statistical analysis.


RESULTS
The anxiety level at induction was high in all groups (P < 0.05). There was no difference between groups in respect to anxiety at other measurement times. A relation between preoperative anxiety level and postoperative behavioural disturbances was determined (P < 0.05). Some behavioural disturbances as nightmare/night fear and desire of sleeping with parents were rarely seen in intravenous propofol induction group (P < 0.05).


CONCLUSIONS
Addition of subhypnotic dose of propofol to sevoflurane induction did not reduce the incidence of postoperative behavioural disturbances.
Bal
N
N
Department of Anaesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Saricaoglu
F
F
Uzun
S
S
Dal
D
D
Celebi
N
N
Celiker
V
V
Aypar
U
U
D000233:Adenoidectomy; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001007:Anxiety / Q000517:prevention & control*; D002648:Child; D002652:Child Behavior / Q000187:drug effects* / Q000523:psychology; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000627:therapeutic use; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D015742:Propofol / Q000627:therapeutic use; D000077149:Sevoflurane; D011795:Surveys and Questionnaires; D013997:Time Factors; D014068:Tonsillectomy
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol