title: Are postoperative behavioural changes after adenotonsillectomy in children influenced by the type of anaesthesia?: A randomised clinical study.
abstract: BACKGROUND
  Negative postoperative behavioural changes (NPOBCs) are very frequent in children after surgery and general anaesthesia. If they persist, emotional and cognitive development may be affected significantly.
  
  
  OBJECTIVE
  To assess whether the choice of different anaesthetic techniques for adenotonsillectomy may impact upon the incidence of NPOBC in repeated measurements.
  
  
  METHODS
  A randomised, controlled, parallel-group trial.
  
  
  METHODS
  University Hospital Split, Croatia.
  
  
  METHODS
  Sixty-four children (aged 6 to 12 years, ASA 1 to 2) undergoing adenotonsillectomy assigned into one of two groups: sevoflurane (S) (n = 32) or total intravenous anaesthesia (TIVA) (n = 32).
  
  
  METHODS
  Permuted-block randomisation with random block sizes of 4, 6 and 8, administering anaesthesia, and evaluation of NPOBC with the Post Hospitalization Behavior Questionnaire (PHBQ: 27 items describing six subscales). The PHBQ was filled out by parents at postoperative days (POD) 1, 3, 7 and 14, and 6 months after surgery.
  
  
  METHODS
  Differences in numbers of NPOBCs between two anaesthesia techniques, and NPOBC analysis by subscales.
  
  
  RESULTS
  The prevalence of at least one NPOBC after surgery ranged from a maximum of 80% [95% confidence interval (CI) 71 to 90%] on POD 1 to a minimum of 43% (95% CI 31 to 56%) 6 months after surgery. Absolute risk reduction for at least one NPOBC in the TIVA group compared with the S group increased from 0.24 on POD 1 to 0.55 6 months after surgery. The number of NPOBCs was also lower in the TIVA group [median 5, interquartile range (IQR) 2 to 10] than in the S group (median 22, IQR 10 to 32) (P < 0.001). The overall number of NPOBCs within PHBQ subscales was significantly lower in the TIVA group than in the S group. The largest difference in the number of NPOBCs between groups was observed for the separation anxiety subscale (mean 5, 95% CI 1 to 9; P < 0.001) followed by the general anxiety subscale (mean 4, 95% CI 3 to 5; P < 0.001) and apathy/withdrawal subscale (mean 3, 95% CI 1 to 5; P < 0.001).
  
  
  CONCLUSIONS
  The prevalence of NPOBC after elective adenotonsillectomy in 6 to 12-year-old children was very high (80%). The choice of anaesthetic technique for adenotonsillectomy in children influenced the incidence and type of NPOBC. Sevoflurane/nitrous oxide anaesthesia was associated with more frequent and prolonged NPOBCs than TIVA, especially in the separation anxiety, general anxiety and withdrawal/apathy subscales.
authors.affiliation: From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Split, Split, Croatia (SSS, MC, NE, DML), the Faculty of Philosophy, University of Split (GK), and the Department of ENT Surgery, University Hospital Split, Split, Croatia (ZR).
authors.forename: Sanda Stojanovic
authors.initials: SS
authors.lastname: Stipic
authors.forename: Mladen
authors.initials: M
authors.lastname: Carev
authors.forename: Goran
authors.initials: G
authors.lastname: Kardum
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Roje
authors.forename: Damira Milanovic
authors.initials: DM
authors.lastname: Litre
authors.forename: Neven
authors.initials: N
authors.lastname: Elezovic
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects / Q000639:trends*; D000768:Anesthesia, General / Q000009:adverse effects / Q000639:trends*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000639:trends*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology*; D000077149:Sevoflurane; D014068:Tonsillectomy / Q000009:adverse effects / Q000639:trends*
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane