Abstract PR279

Abstract

Background & Objectives: In paediatric studies, the incidence of post-operative maladaptive behaviour (POMB) has been quoted to be as high as 80%, and distress during inhalational induction has been proposed as a predictor of negative behavioural change. This study primarily aims to establish the incidence and duration of this change in our paediatric patients coming for ambulatory surgery, and secondarily establish the degree of induction compliance or postoperative pain in recovery as a risk factor. Materials & Methods: We studied 134 children of ages 2-12 years, of ASA physical status I and II presenting for minor ambulatory surgeries amenable to peripheral nerve blocks or local anaesthetic infiltration. The children received no pre-medication but were parent-accompanied for an inhalational induction using sevoflurane in nitrous/oxygen mix. Behavioural compliance was assessed with the Induction Compliance Checklist, and the anaesthetic was conducted at the attending anaesthetists’ discretion. Pain was assessed in the recovery area every 10 minutes from the time of awakening till discharge to the stage 2 recovery area. After hospital discharge, follow-up telephone interviews on post-operative days 1, 2, 3, 7, 14 and 30 were conducted using the Post Hospital Behaviour Questionnaire. If there were no negative behavioural changes after three consecutive calls, follow-up phone calls were ceased. Results: A total of 134 children were studied, with a median age of 6yo and median weight of 20.25kg. On the first day at home following surgery, 47.8% exhibited negative behaviour change. This decreased to 32.1%, 14.2%, 7.5% then 3% on days 2, 3, 7 and 14 after surgery. Thirty days after surgery, 1 child still manifested post-operative maladaptive behaviour. On further statistical analysis, the degree of induction compliance correlates to the risk of developing postoperative maladaptive behaviour (p=0.026). Postoperative pain in recovery does not however, correlate to the development of POMB. Conclusion: The incidence of post-operative maladaptive behaviour in 2-12yo in our institution coming for minor day surgical procedures is 47.8%. Secondary analysis of the data suggests that it correlates with poor compliance at inhalational induction of anaesthesia, but not with the postoperative pain in recovery. The use of strategies and pharmacological aids to improve compliance at induction and thus reduce the risk of development of POMB should be further studied.