Intraoperative music application in children and adolescents - a pilot study.

BACKGROUND: Hospitalization, surgery and anaesthesia may lead to new-onset maladaptive behaviour, emotional distress and trauma. This pilot study aims to investigate the influence of intraoperatively applied music on post-operative behaviour in children and adolescents. METHODS: Children with an ASA physical state classification of I or II, aged from 4 to 16 years and scheduled for elective circumcision or inguinal hernia repair under combined general and caudal anaesthesia were included. The children were randomized into two groups. They wore headphones during surgery, and were either exposed to music or not. All involved staff were blinded. Post-operative behaviour was documented by parents on day 7, 14 and 28 after surgery, using a questionnaire adapted from the "Post Hospitalization Behavioural Questionnaire" (PHBQ). Overall occurrence of at least one item indicating maladaptive behaviour was the primary outcome. Data are presented as median (interquartile range). RESULTS: In total, 135 children aged 6.6 (5.3-8.5) years, weighing 22 (19-29) kg, were included, with 112 completed questionnaires returned. Overall occurrence of at least one maladaptive item was lower in the music group, with a significantly lower incidence on day 7 (51% vs. 77% in controls; P < 0.01). CONCLUSION: Intraoperative music application in children undergoing minor surgical procedures may reduce the incidence of post-operative maladaptive behaviour within the first week.

[Negative behavioral changes in children and adolescents after anesthesia : Development of a German language version of the Post Hospitalization Behavior Questionnaire]. / Verhaltensauffälligkeiten von Kindern und Jugendlichen nach Narkose : Entwicklung einer deutschsprachigen Version des Post Hospitalization Behavior Questionnaire.

BACKGROUND: Negative behavioral changes after anesthesia in children are common. The Post Hospitalization Behavior Questionnaire (PHBQ) was particularly developed and has been widely used in English-speaking countries to investigate such behavioral changes. The PHBQ consists of 27 questions related to behavioral features observed by parents after anesthesia or hospitalization, each involving comparison with their baseline status. AIM: A comparable diagnostic tool in German should be established. MATERIAL AND METHODS: The PHBQ was translated into German using a well defined back-translation method. A 3-point Likert scale was used to categorize behavioral features as less than, equal to or more than baseline. Overall 600 questionnaires were given out at children's hospital discharge, following surgical or medical procedures or examinations with or without concurrent anesthesia or deep sedation. After questionnaires were returned, factor and item analysis was conducted. Cronbach's alpha was calculated to determine internal consistency as a measure of reliability. RESULTS: In total, 155 returned and completed questionnaires were assessed, with patients' age ranging from 1.1 to 15.9 (median 5.7) years and length of hospitalization between 1 to 15 (median 2.5) days. The German translation of the PHBQ has a factorial structure that is similar to the English version, and its psychometric properties are also similar. After analysis of the main components and consideration of the Scree plot, either 6 or 7 factors were indicated. Analogously to the original version, we chose 6 factors, which explain 58% of variance. Items were not identically assigned to factors as with the original version, and terms used to describe the factors were slightly adapted. Reliability was adequate, with Cronbach's alpha for the 6 factors being between 0.6 and 0.82 (for total scale: Cronbach's alpha = 0.89, compared to 0.82 for the original version). Children younger than 5 years showed more negative behavioral changes than older children. There were no gender differences. CONCLUSION: With the German translation of the PHBQ presented here an instrument is available to detect negative behavioral changes after anesthesia in children among German speaking populations. The translation is comparable to the English version with minor differences concerning its factorial structure, which may be due to the predominant role of anxiety in all items. Like the original, this questionnaire does not per se discriminate between anesthesia and hospitalization induced behavioral changes. However, the German translation of the PHBQ is a questionnaire that is feasible for clinical routine and scientific settings and can be easily and quickly completed by caregivers.

Evaluation of propofol for repeated prolonged deep sedation in children undergoing proton radiation therapy.

BACKGROUND: The aim of this study is to evaluate the safety and sufficiency of a fixed dose rate propofol infusion for repeated prolonged deep sedation in children for proton radiation therapy (PRT). METHODS: With ERB approval, we recorded anaesthesia monitoring data in children undergoing repeated prolonged propofol sedation for PRT. Sedation was introduced with a single bolus of i.v. midazolam 0.1 mg kg(-1) followed by repeated small boluses of propofol until sufficient depth of sedation was obtained. Sedation was maintained with fixed dose rate propofol infusion of 10 mg kg(-1) h(-1) in all patients up to the end of the radiation procedure. Patient characteristics, number and duration of sedation, propofol induction dose, necessity to alter propofol infusion rate, and heart rate, mean arterial pressure, respiratory rate were noted at the end of the radiation procedure before cessation of the propofol infusion. Data are mean (sd) or range (median) as appropriate. RESULTS: Eighteen children aged from 1.4 to 4.2 yr (2.6 yr) had 27.6 (sd 2.0) (497 in total) radiation procedures within 44.1 (4.0) days lasting 55.7 (8.8) min. Propofol bolus dose for induction, monitoring, and positioning was 3.7 (1.0) mg kg(-1). Propofol bolus requirements were quite stable over the successive weeks of treatment and variability was larger between individuals than over time. In none of the children did propofol infusion rate need to be changed from the pre-set 10 mg kg(-1) h(-1) flow rate because of haemodynamic state, respiratory conditions or inadequate anaesthesia. CONCLUSIONS: Repeated prolonged deep sedation over several weeks in very young children using a fixed rate propofol infusion was safe and adequate for all patients.