Observational study of perioperative behavior changes in children having teeth extracted under general anesthesia
Observational study of perioperative behavior changes in children having teeth extracted under general anesthesia
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DOI：
10.1111/pan.12362
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发表时间：
2014-05-01
影响因子：
1.7
通讯作者：
Kilpatrick, Nicky
中科院分区：
文献类型：
--
作者：
Beringer, Richard M.;Segar, Philip;Kilpatrick, Nicky
背景围手术期行为障碍在儿童中很常见。在麻醉诱导、恢复期间和出院回家后，可能会出现消极的行为改变。在英国，关于这个问题的研究很少。目的本研究的目的是确定我们机构内行为改变的发生率，并确定哪些儿童的风险增加。方法对2 ~ 12岁健康儿童在全麻下择期拔牙进行前瞻性观察研究。评估包括：孩子和父母的焦虑状态；麻醉诱导时的焦虑和行为（改良耶鲁术前焦虑量表和小儿麻醉行为评分）；PACU（小儿麻醉出现性谵妄[PAED]量表）；术后第1天和第7天的家庭行为（住院后行为问卷）。对数据进行关联和相关性检查。结果共纳入儿童102例，中位年龄6岁。67%的患者在麻醉诱导过程中表现出高度焦虑，尽管只有3%的患者表现出明显的声音或身体抵抗。13%的人PAED得分在10分以上。住院后第1天有52%的儿童表现出行为改变，第7天有22%；并且与：先前的创伤性医疗保健经历，男性和麻醉诱导期间的痛苦有关。结论麻醉患儿手术过程中行为障碍较为常见。预测哪些儿童的风险增加可能使我们能够调整这些儿童的管理，以尽量减少不良行为的改变。
BackgroundPerioperative behavioral disturbance is common in children. Negative behavior changes may be seen during induction of anesthesia, during recovery and following discharge home. There has been little research on this subject in the UK.ObjectivesThe aim of this study was to determine the incidence of behavioral changes within our institution and identify which children are at increased risk.MethodsA prospective observational study of healthy children aged two to 12 undergoing elective dental extractions under general anesthesia. Assessments included: the child's and parent's state anxiety; anxiety and behavior during induction of anesthesia (modified Yale preoperative anxiety scale and the pediatric anesthesia behavior score); behavior in PACU (pediatric anesthesia emergence delirium [PAED] scale); behavior at home on postoperative days 1 and 7 (post hospitalization behavior questionnaire). Data were examined for associations and correlations.ResultsOne hundred and two children with a median age of 6years were recruited. Sixty-seven per cent exhibited high anxiety during induction of anesthesia, although only 3% demonstrated significant vocal or physical resistance. Thirteen per cent had a PAED score of 10 or more. Post-hospitalization behavior changes were demonstrated by 52% of children on day 1 and 22% on day 7; and were associated with: a previous traumatic healthcare experience, male sex, and distress during induction of anesthesia.ConclusionsPerioperative behavioral disturbance is common in children undergoing anesthesia. Predicting which children are at increased risk may allow us to adapt the management of these children in order to minimize adverse behavior changes.