Anesthesia induction, emergence, and postoperative behaviors in children with attention-deficit/hyperactivity disorders.
OBJECTIVE
Given the increasing prevalence of attention-deficit and attention-deficit hyperactivity disorders (ADHD), anesthesiologists are now presented with a greater number of children who are diagnosed with these conditions. This prospective, observational study was designed to compare anesthesia induction, emergence, and postoperative behaviors in children with and without ADHD.


METHODS
The sample included 268 children, 4-17 years of age undergoing elective surgery with a confirmed diagnosis of ADHD. A cohort of children without ADHD, matched for age, gender, and procedure served as controls. Preoperative cooperation, induction, and emergence behaviors were measured using established scales. Postoperative maladaptive behaviors were measured using a modified Post-Hospital Behavioral Questionnaire that was administered via telephone 1 week after surgery.


RESULTS
Children with ADHD were significantly less cooperative at induction of anesthesia compared with controls (20.9% vs 10.6% respectively, P = 0.001). Although some control children exhibited an increase in maladaptive behaviors postoperatively, these behaviors were significantly greater among children with ADHD. In particular, relative to their normal behaviors, children with ADHD had greater difficulties in concentration and decision-making; were more disobedient, impulsive, fidgety, had poor appetite; were difficult to talk to; and exhibited an increase in temper tantrums following surgery.


CONCLUSIONS
This is the first prospective study to our knowledge that has examined the perioperative and postoperative behaviors of children with ADHD compared to those without this disorder. These results are important in alerting anesthesiologists, parents, and teachers to the potential for difficulties during induction of anesthesia and postoperative behavioral problems at home and in school, respectively.
Tait
Alan R
AR
Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109, USA. atait@umich.edu
Voepel-Lewis
Terri
T
Burke
Constance
C
Doherty
Tara
T
D000293:Adolescent; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000523:psychology*; D002648:Child; D002652:Child Behavior / Q000187:drug effects / Q000523:psychology; D002653:Child Behavior Disorders / Q000150:complications / Q000523:psychology*; D002675:Child, Preschool; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000523:psychology*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011795:Surveys and Questionnaires