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Preoperative Anxiety and Emergence Delirium and Postoperative Maladaptive Behaviors

Kain, Zeev N. MD, MBA; Caldwell-Andrews, Alison A. PhD; Maranets, Inna MD; McClain, Brenda MD; Gaal, Dorothy MD; Mayes, Linda C. MD; Feng, Rui MS; Zhang, Heping PhD

doi: 10.1213/01.ANE.0000136471.36680.97
Pediatric Anesthesia: Research Report

Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O2/N2O and who did not receive midazolam were recruited. Children’s anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child’s state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

IMPLICATIONS: A practicing clinician can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

The Center for the Advancement of Perioperative Health, and the Departments of Anesthesiology, Pediatrics, and Child and Adolescent Psychiatry, Yale University School of Medicine, Department of Epidemiology, School of Public Health, Yale University, New Haven, Connecticut

Supported, in part, by National Institutes of Health grants NICHD, R01HD37007–01 and NIDA, R01DA12468 and the Patrick and Catherine Weldon Donaghue Medical Research Foundation.

Accepted for publication June 3, 2004.

Address correspondence and reprint requests to Zeev N. Kain, MD, MBA, Department of Anesthesiology, Yale University School of Medicine 333 Cedar Street, New Haven, CT 06510. Address e-mail to zeev.kain@yale.edu.

© 2004 International Anesthesia Research Society