Abstract
Objective 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.
Materials and Methods 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.
Results 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]).
Conclusion 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.
Keywords
parental presence during induction of anesthesia - emergence delirium - postoperative
maladaptive behavioral changes
