Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Department of Pediatric Anesthesiology, Hospital Universitario La Paz and H. Quironsalud, Madrid, Spain.
Eur J Pediatr Surg. 2024 Aug;34(4):368-373. doi: 10.1055/a-2128-0974. Epub 2023 Jul 12.
Surgical intervention in pediatric patients can cause variable degrees of psychological stress with potential consequences in the perioperative period and even in the long term, after hospital discharge in the form of behavioral changes days and months later. The aim of our study was to determine which preoperative preparation strategy reduces postoperative maladaptive behavioral changes in children undergoing ambulatory pediatric surgery.
This prospective observational study included 638 pediatric American Society of Anesthesiologists physical status I or II patients who underwent ambulatory pediatric surgery. They were grouped into four preoperative preparation groups: not premedicated (NADA), premedicated with midazolam (MDZ), parental presence during induction of anesthesia (PPIA), and parental presence during induction of anesthesia and premedicated with midazolam (PPIA + MDZ). All patients included in the study were contacted by telephone during 1 year posthospital discharge to assess the postoperative maladaptive behavioral changes using the Posthospitalization Behavior Questionnaire (PHBQ). We performed a multivariate analysis to evaluate the influence of type of preparation and behavioral changes.
Patients in the PPIA and PPIA + MDZ preparation groups presented less postoperative maladaptive behavioral changes compared to patients in the NADA and MDZ groups (odds ratio [OR]: 1.8 [1.1-2.8] and OR 2.2 [1.03-4.49]) during the first week and first month. The intensity of emergence delirium measured by the Pediatric Anesthesia Emergence Delirium (PAED) scale increases the probability of postoperative maladaptive behavioral changes (OR: 1.05 [1.006-1.103]).
The presence of parents during induction of anesthesia (PPIA and PPIA + MDZ) is a very effective strategy in reducing postoperative behavioral changes. These benefits are more significant in children under 5 years of age.
手术干预会给儿科患者造成不同程度的心理压力，这些压力可能会在围手术期产生潜在影响，甚至在出院后数月内以行为变化的形式显现。本研究旨在确定哪种术前准备策略能减少接受日间小儿外科手术的儿童术后适应不良的行为变化。
这是一项前瞻性观察研究，纳入了 638 名接受日间小儿外科手术的美国麻醉医师协会身体状况 I 或 II 级的儿科患者。他们被分为四组术前准备组：未予镇静（NADA）、咪达唑仑镇静（MDZ）、麻醉诱导时父母在场（PPIA）和麻醉诱导时父母在场并予咪达唑仑镇静（PPIA+MDZ）。所有纳入研究的患者在出院后 1 年内通过电话联系，使用出院后行为问卷（PHBQ）评估术后适应不良的行为变化。我们进行了多变量分析，以评估准备类型和行为变化的影响。
与 NADA 和 MDZ 组相比，PPIA 和 PPIA+MDZ 组的患者在术后第一周和第一个月出现的术后适应不良的行为变化较少（比值比[OR]：1.8 [1.1-2.8] 和 OR 2.2 [1.03-4.49]）。儿科麻醉苏醒期谵妄量表（PAED）测量的苏醒期谵妄严重程度增加了术后适应不良行为变化的概率（OR：1.05 [1.006-1.103]）。
麻醉诱导时父母的陪伴（PPIA 和 PPIA+MDZ）是减少术后行为变化的有效策略。在 5 岁以下的儿童中，这种益处更为显著。
