RESUMO
BACKGROUND: Perioperative behavioral disturbance is common in children. Negative behavior changes may be seen during induction of anesthesia, during recovery and following discharge home. There has been little research on this subject in the UK. OBJECTIVES: The aim of this study was to determine the incidence of behavioral changes within our institution and identify which children are at increased risk. METHODS: A prospective observational study of healthy children aged two to 12 undergoing elective dental extractions under general anesthesia. Assessments included: the child's and parent's state anxiety; anxiety and behavior during induction of anesthesia (modified Yale preoperative anxiety scale and the pediatric anesthesia behavior score); behavior in PACU (pediatric anesthesia emergence delirium [PAED] scale); behavior at home on postoperative days 1 and 7 (post hospitalization behavior questionnaire). Data were examined for associations and correlations. RESULTS: One hundred and two children with a median age of 6 years were recruited. Sixty-seven per cent exhibited high anxiety during induction of anesthesia, although only 3% demonstrated significant vocal or physical resistance. Thirteen per cent had a PAED score of 10 or more. Post-hospitalization behavior changes were demonstrated by 52% of children on day 1 and 22% on day 7; and were associated with: a previous traumatic healthcare experience, male sex, and distress during induction of anesthesia. CONCLUSIONS: Perioperative behavioral disturbance is common in children undergoing anesthesia. Predicting which children are at increased risk may allow us to adapt the management of these children in order to minimize adverse behavior changes.
Assuntos
Anestesia Geral/psicologia , Comportamento Infantil/efeitos dos fármacos , Comportamento Infantil/psicologia , Período Perioperatório/psicologia , Extração Dentária/psicologia , Período de Recuperação da Anestesia , Ansiedade/psicologia , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pais/psicologia , Estudos Prospectivos , Fatores Sexuais , Inquéritos e Questionários , Reino UnidoRESUMO
Consent for magnetic resonance imaging under anesthesia in children is complex - it does not fit the usual model of consent for invasive procedures and requires the collaboration of multiple specialists from different disciplines. This article discusses the issues surrounding consent for this procedure, sets out four essential elements of the consent process, and proposes that, of the specialists involved, the referring clinician is best placed to discuss the options with parents and obtain written consent.
