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

Abstract

SummaryThe purpose of this prospective multicentre survey was to evaluate the occurrence and the type of changes in children's behaviour during the first 4 weeks following the day of surgery, and to assess the significance of some patient-related factors on the incidence. Pre-and postoperative questionnaires were completed by the parents of 551 children aged 4 months to 13.4 years in five hospitals incorporating nine operative units in Northern Finland. The overall incidence of problematical behavioural changes was 47% and that of beneficial changes 17%. Problematical changes were most common in the 1.0 to 2.9 year olds and the incidence decreased significantly from 46% on the day of the operation to 9% 4 weeks later (p < 0.0001). Predictors by multiple logistic regression analysis were age, mild pain at home following surgery, severe pain and a previous bad experience of health care which had adversely affected the attitude of the child towards doctors or nurses. Hospital influenced playing was a significant factor 3 and 4 weeks after the operation. By the 4th week, beneficial and problematical changes were equally common (9%). Gender, previous operations and experience of repeated paracenteses (for treatment of middle ear infection) did not have a significant effect on the incidence. Pain on the day of the operation predicted the occurrence of behavioural problems up to the 4th week, 2-4 weeks longer than the duration of pain itself. The results emphasise the importance of effective prevention of postoperative pain as well as the importance of avoiding unpleasant experiences in all contacts children have with health care. Playing could perhaps be used to help children cope with a short hospital experience.

Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?

“…and there is evidence that patients with the apolipoprotein epsilon 4 allele experience postoperative delirium at more than twice the rate of patients without apolipoprotein epsilon, adding a genetic link to account for some of the variability. 130 If the association between POCD and deep sedation had been discovered before the association between POCD and general anesthesia, perhaps we would have come more readily to the hypothesis that lighter anesthesia 119 -122 and deeper sedation 128,129 occupy an equivalent middle ground (approximately BIS [45][46][47][48][49][50][51][52][53][54][55] when it comes to increasing the risk of POCD relative to both lighter sedation (approximately BIS ≥60) and deeper anesthesia (approximately BIS [35][36][37][38][39][40][41][42][43][44][45]. 131 …”

Ansiedade, a criança e os pais

“…Alterações de comportamento comuns após a cirurgia incluem irritabilidade, ansiedade de separação, pesadelos, problemas na alimentação, choros noturnos e desobediência. A enurese noturna é menos freqüente (0,8% na 2ª semana de pós-operatório) 8,12 . Kain e col. 8 demonstraram que 67% das crianças apresentavam novas alterações de comportamento no dia seguinte à cirurgia, 45% no segundo dia e 23%, na 2ª semana de pós-operatório.…”

“…Segundo Bevan e col. 20 , as crianças mais novas são mais ansiosas do que as mais velhas durante a indução. Outros trabalhos mostraram o mesmo comportamento durante a separação dos pais e também que elas são menos cooperativas durante indução da anestesia do que as crianças mais velhas 12,21 . Por outro lado, Kain e col. 13 mostraram que, na entrada do centro cirúrgico, as crianças com mais de 7 anos de idade são mais ansiosas do que as da faixa etária de 4 a 7 anos.…”

“…Entretanto, alguns autores encontraram em um extenso estudo em crianças, que a ansiedade durante a indução não variou com a idade 22 . No pós-operatório, alterações de comportamento parecem ocorrer com mais freqüência em crianças mais novas 12,23 .…”

“…Foi observado que elevados níveis de ansiedade pré-operatória estão associados a maior intensidade de dor pós-operatória [32][33][34] , maior demanda por analgésico em analgesia controlada pelo paciente 34,35 , baixos níveis de satisfação com o tratamento 34 , e alterações de comportamento após a cirurgia 12 . Por outro lado, crianças com dor pós-operatória moderada a intensa, têm 14 vezes mais probabilidade de desenvolver ansiedade intensa 1 .…”