title: Factors associated with a difficult induction of general anaesthesia.
abstract: BACKGROUND
  Many children experiencing a procedure under general anaesthetic (GA), including those having surgery for cochlear implantation, display behaviours indicative of distress during induction of anaesthesia. It would be useful to ascertain which factors in the pre-operative period are related to the presence of distress at induction in order to target appropriate psychological preparation.
  
  
  METHODS
  The families of 84 children aged 4-7 years undergoing a procedure under GA (including insertion of a cochlear implant) completed three questionnaires assessing temperament, behavioural difficulties, and pre-operative worries. Demographic variables were also recorded. The outcome measure was the amount of behavioural distress at induction.
  
  
  RESULTS
  Statistically significant relationships with the outcome measure of distress at induction were obtained for three factors; an emotional or sociable temperament, and the number of previous procedures. Further, children receiving inhalation inductions displayed greater distress than those receiving intravenous inductions.
  
  
  CONCLUSIONS
  Undergoing cochlear implantation under GA is a major life event for many recipients. Psychologically preparing children for this has been found to be efficacious, but is not currently available to all children. It is suggested that preparation can be targeted at children, as identified in this study, who have elevated emotionality or sociability scores or who have previous experience of procedures under general anaesthesia. This is of particular current relevance as children are increasingly likely to require re-implantation as they grow older and as unilaterally implanted children are now being offered a sequential bilateral implant, both necessitating further surgery.
authors.affiliation: Paediatric Auditory Implant Service, Guy's and St Thomas' Foundation NHS, London, UK. jenny.cropper@gstt.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Cropper
authors.forename: L
authors.initials: L
authors.lastname: Edwards
authors.forename: D
authors.initials: D
authors.lastname: Hearst
authors.forename: E
authors.initials: E
authors.lastname: Durling
authors.forename: C
authors.initials: C
authors.lastname: Ward
authors.forename: H
authors.initials: H
authors.lastname: Albon
authors.forename: C
authors.initials: C
authors.lastname: Roberts
authors.forename: S
authors.initials: S
authors.lastname: Thorpe
authors.forename: J
authors.initials: J
authors.lastname: Murray
mesh_terms: D000768:Anesthesia, General / Q000379:methods* / Q000523:psychology; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001007:Anxiety / Q000209:etiology / Q000503:physiopathology*; D016009:Chi-Square Distribution; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000523:psychology; D008297:Male; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous