Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: A prospective observational study.

Abstract

Emergence delirium is well known as early postoperative behavioral change after general anesthesia. However, it is unclear whether children with emergence delirium have negative behavioral changes after hospital discharge. This observational study investigated the association between emergence delirium and posthospital behavioral changes. One-hundred preschoolers aged 2-7years undergoing elective surgery were enrolled in 2 tertiary university hospitals. Preoperative anxiety level was assessed using modified Yale preoperative anxiety scale. Emergence delirium was defined via pediatric anesthesia emergence delirium score ≥12 at any time in the recovery room. We divided the delirium score into a delirium-specific score (the sum of the first 3 items: eye contact, purposeful movement, and awareness of surrounding) and a pain-related score (the sum of the last 2 items: restlessness and inconsolability). High delirium scores represent severe emergence delirium. Posthospital behavioral changes were assessed by a change in Child Behavior Checklist 1.5-5 scores before and 1week after surgery. The primary outcome was the total behavior checklist scores 1week after surgery. Multiple linear regression was performed to identify risk factors for posthospital behavioral changes. Children with emergence delirium (n=58) had higher postoperative behavior checklist scores than children without emergence delirium (n=42) [mean (SD), 22.8 (17.5) vs. 14.0 (12.1); mean difference (95% CI), 8.8 (1.5-16.2)]. Increases in preoperative anxiety level [regression coefficient (b) (95% CI) =0.241 (0.126-0.356)] and peak delirium-specific score [b=0.789 (0.137-1.442)] were associated with an increase in behavior checklist score 1week after surgery, while pain-related score, type of surgery, premedication, and age were not. Children with emergence delirium developed more severe behavior changes 1week after surgery than those without emergence delirium. High preoperative anxiety level and emergence delirium scores were associated with posthospital behavioral changes.