engleski

Does total intravenous anesthesia decrease postoperative behavioral changes after adenotonsillectomy in children?

Background and Goal of Study: Postoperative behavioral changes (PBC) occur in up to 50% of children undergoing surgery and general anesthesia. They include general anxiety, sleep disorders, enuresis and temper tantrums ; if PBC persist, the emotional and cognitive development may be significantly affected (1). Total intravenous anesthesia (TIVA) is increasingly used in routine pediatric anesthesia. The aim of this study was to assess whether the choice of different anesthetic techniques for adenotonsillectomy may impact upon the incidence of PBC in repeated measurements. Materials and Methods: The children (n=36), age 6‐12 yrs, were randomized into 2 groups: TIVA (n=18) and sevoflurane (S) (n=18). After applying EMLA cream, all patients had iv line before the induction and were given midazolam 0.05 μg/kg. In TIVA group anesthesia was induced with propofol, fentanyl and vecuronium, and maintained with continuous infusion of propofol. In S group, after fentanyl 1 μg/kg anesthesia was induced and maintained with sevoflurane in O2/N20 (50:50) mixture. BIS monitoring was used and depth of anesthesia accordingly adjusted. All patients were given paracetamol 15 mg/kg and dexamethasone 0.2 mg/kg. PBC were evaluated with Post Hospitalization Behavior Questionnaire (PHBQ), consisting of 27 items describing 6 subscales: General Anxiety, Separation Anxiety, Sleep Anxiety, Eating Disturbances, Aggression Against Authority and Apathy/Withdrawal (2). PHBQ was fulfilled by parents at days 1, 3, 7 and 15, as well as 6 months after surgery. The data were statistically analyzed with repeated measures ANOVA. Results and Discussion: Regarding the Separation Anxiety, Eating Disturbances and Aggression Against Authority subscales, there were significant differences between TIVA and S group (P< 0.05) in all repeated measurements, with greater mean values of PBC in S group. Regarding the General Anxiety, Sleep Anxiety and Apathy/Withdrawal subscales, there were no significant differences either in repeated measurements within groups, or between TIVA and S group, although higher mean values of PBC were recorded in group S (P>0.05). Conclusion: The choice of anesthetic technique could affect PBC. Children anesthetized with TIVA for adenotonsillectomy had significantly less separation anxiety, eating disturbances and aggression against authority estimated by results of PHBQ.

general anesthesia; child; behavioral changes; questionnaire; tonsillectomy

ESA Best Abstract Prize Competition (BAPC), Euroanesthesia 2013, Barcelona, Spain