Anaesthesia induction in children. Ability to predict cooperation

Abstract

Summary This study identifies some of the preoperative characteristics that may influence a child's cooperation during induction of anaesthesia, and the ability of both resident and staff anaesthetists to predict cooperation. Five hundred unmedicated children aged 2–12 participated in the study. The characteristics that influenced cooperation were identified. Children four years of age or younger cooperated less regardless of race, gender or the technique used. Children who had had prior anaesthetics cooperated significantly less than those who had no previous anaesthesia. The child's response to a previous anaesthetic correlated with cooperation for the current anaesthetic. The child's cooperation during blood drawing correlated with cooperation during induction. Preoperative preparation resulted in improved cooperation ratings. No differences in cooperation were observed for different induction techniques. Success in prediction was correlated with the anaesthetist's training and experience. Anaesthetists had more trouble predicting difficult than smooth inductions.

Behavioural changes in children following day‐case surgery: a 4‐week follow‐up of 551 children

“…One bad experience, usually painful or involving restraint or force, is enough to cause the child to lose his/her trust in all areas of health care. Although an effect has been seen in some studies [6,10,11], we did not find previous operations to affect the child's co-operation in hospital or behaviour at home. One difference may be that, in the earlier studies, anaesthesia had been mostly induced by mask, while we commonly used intravenous induction.…”

“…Waking up at night increased more often after anaesthetic induction with thiopentone, in 70/503 (14%) children, compared with 0/26 if propofol had been used (difference 14%, 95% CI 11-17), and after premedication with diazepam, in 44/274 (16%) compared with 20/219 (9%) if midazolam had been given (difference 7%, 95% CI 1-13). Waking up at night increased in 61/342 (18%) children who had been given opioids during anaesthesia compared with 14/209 (7%) of those who had no opioids (difference 11%, 95% CI 6-16), and in 33/127 (26%) of those who had postoperative opioids compared with 42/424 (10%) of the ones who had not been given opioids postoperatively (difference 16%, 95% CI [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] ................................................................................................................................................................................................................................................ …”

“…Even though the age ranges in many studies have been narrow, changes in behaviour have occurred more often in young children [3,4,7]. Anaesthetic techniques have not affected the incidence [8,9], but a relation to previous operations has been seen [6,10,11]. Our purpose was to assess the incidence and quality of behavioural changes seen in children after day-case surgery and to find out the significance of some factors in the children themselves and their previous experiences of health care on the incidence.…”

Behavioural changes and children's memories after intravenous, inhalation and rectal induction of anaesthesia

“…In the study by Breitkopf & Biittner (19), the children aged between two and six years with previous anaesthesia experiences behaved with significantly more anxiety immediately before the premedication, but not at the induction of anaesthesia, compared with the children operated on for the first time. In another study, the children aged between two and 12 years who had previously undergone one or more anaesthesia cooperated significantly less at the induction than those coming into the OR for the first time (14). In these studies, the children with previous experiences had mostly undergone an inhalational induction, while in our study the majority of children had experienced an intravenous induction.…”