title: Real-time assessment of perioperative behaviors and prediction of perioperative outcomes.
abstract: OBJECTIVE
  New onset maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, attention-seeking, and fear of being alone are common in children after outpatient surgery. Preoperative anxiety, fear and distress behaviors of children predict postoperative maladaptive behaviors as well as emergence delirium. Parental anxiety has also been found to influence children's preoperative anxiety. Currently, there is no real-time and feasible tool to effectively measure perioperative behaviors of children and parents. We developed a simple and real-time scale, the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to assess perioperative child and parent behaviors that might predict postoperative problematic behavior and emergence excitement.
  
  
  METHODS
  We used the PACBIS to evaluate perioperative behaviors during anesthetic induction and recovery in a sample of 89 children undergoing tonsillectomies and adenoidectomies, and their parents. Preoperative anxiety with the modified Yale Preoperative Anxiety Scale, compliance with induction of anesthesia with Induction Compliance Checklist, and incidence of emergence excitement were also recorded.
  
  
  RESULTS
  The PACBIS demonstrated good concurrent validity with modified Yale Preoperative Anxiety Scale and Induction Compliance Checklist and predicted postanesthetic emergence excitement.
  
  
  CONCLUSIONS
  The PACBIS is the first real-time scoring instrument that evaluates children's and parents' perioperative behavior. The specific behaviors identified by the PACBIS might provide targets for interventions to improve perioperative experiences and postoperative outcomes.
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 2001, Cincinnati, OH 45229, USA. senthilkumar.sadhasivam@cchmc.org
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Sadhasivam
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Cohen
authors.forename: Alexandra
authors.initials: A
authors.lastname: Szabova
authors.forename: Anna
authors.initials: A
authors.lastname: Varughese
authors.forename: Charles Dean
authors.initials: CD
authors.lastname: Kurth
authors.forename: Paul
authors.initials: P
authors.lastname: Willging
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: Joel
authors.initials: J
authors.lastname: Gunter
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000523:psychology*; D001007:Anxiety / Q000523:psychology; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D005544:Forecasting; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009726:Nurses; D019990:Perioperative Care / Q000523:psychology*; D011183:Postoperative Complications / Q000523:psychology*; D011184:Postoperative Period; D011300:Preoperative Care / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000523:psychology; D016896:Treatment Outcome