Negative postoperative behaviors in children under general anesthesia

Abstract

Background Children, elected to major surgeries under general anesthesia, experience tremendous stress during perioperative period, and the stress may be associated with negative postoperative behavioral changes(NPOBC), such as nightmares, enuresis, temper tantrum, etc, which may affect both emotional and cognitive development in these children. Objective To promote the awareness of NPOBC, meanwhile, to probe risk factors for its intervention to reduce the incidence of NPOBC and improve the prognosis of these children. Content Clinical trials reveal multiple potential risk factors for NPOBC, including young ages ( 4 d) in hospital, etc. These abnormal behaviors could relate to toxic effects of anesthetics on neuronal development, differentiation, connections, and apoptosis. Moreover, neuroinflammation initiated during surgery and the release of stress hormones in perioperative period could also contribute to these behaviors. Several strategies were implemented in several investigations, including administration of benzodiazepine antidepressant drugs or 2-adrenoceptor agonists, enhancement of support from family, and alteration of anesthetic procedure, etc. However, none of these interventions has convincing effectiveness. Trend There still lacks causal links between the risk factors mentioned above and the incidence of NPOBC. Additionally, the molecular, cellular, and circuit mechanisms underlying NPOBC require further multidisciplinary investigations, which may eventually provide avenues for the treatment and intervention of these behaviors. Key words: Children; Postoperative behavioral changes; Anesthesia, general