Stipic Sanda Stojanovic, Carev Mladen, Kardum Goran, Roje Zeljka, Litre Damira Milanovic, Elezovic Neven
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).
Eur J Anaesthesiol. 2015 May;32(5):311-9. doi: 10.1097/EJA.0000000000000104.
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.
To assess whether the choice of different anaesthetic techniques for adenotonsillectomy may impact upon the incidence of NPOBC in repeated measurements.
A randomised, controlled, parallel-group trial.
University Hospital Split, Croatia.
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).
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.
Differences in numbers of NPOBCs between two anaesthesia techniques, and NPOBC analysis by subscales.
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).
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.
术后负面行为改变（NPOBCs）在接受手术和全身麻醉的儿童中非常常见。如果这些改变持续存在，可能会对儿童的情感和认知发展产生显著影响。
评估在重复测量中，腺样体扁桃体切除术选择不同的麻醉技术是否会影响NPOBC的发生率。
一项随机、对照、平行组试验。
克罗地亚斯普利特大学医院。
64名接受腺样体扁桃体切除术的儿童（年龄6至12岁，ASA 1至2级）被分为两组之一：七氟醚组（S）（n = 32）或全静脉麻醉组（TIVA）（n = 32）。
采用随机区组随机化，随机区组大小为4、6和8，实施麻醉，并使用《出院后行为问卷》（PHBQ：27个项目，描述六个分量表）评估NPOBC。PHBQ由家长在术后第1天、第3天、第7天、第14天以及术后6个月填写。
两种麻醉技术之间NPOBC数量的差异，以及按分量表进行的NPOBC分析。
术后至少出现一种NPOBC的发生率从术后第1天的最高80%[95%置信区间（CI）71%至90%]到术后6个月的最低43%（95%CI 31%至56%）。与S组相比，TIVA组至少出现一种NPOBC的绝对风险降低率从术后第1天的0.24增加到术后6个月的0.55。TIVA组的NPOBC数量也低于S组[中位数5，四分位数间距（IQR）2至10]（中位数22，IQR 10至32）（P < 0.001）。在PHBQ分量表中，TIVA组的NPOBC总数显著低于S组。两组之间NPOBC数量差异最大的是分离焦虑分量表（均值5，95%CI 1至9；P < 0.001），其次是一般焦虑分量表（均值4，95%CI 3至5；P < 0.001）和冷漠/退缩分量表（均值3，95%CI 1至5；P < 0.001）。
6至12岁儿童择期腺样体扁桃体切除术后NPOBC的发生率非常高（80%）。儿童腺样体扁桃体切除术的麻醉技术选择会影响NPOBC的发生率和类型。与TIVA相比，七氟醚/氧化亚氮麻醉与更频繁、更持久的NPOBC相关，尤其是在分离焦虑、一般焦虑和退缩/冷漠分量表中。
