Distress during the induction of anesthesia and postoperative behavioral outcomes

We determined whether children who are extremely anxious during the inducti on of anesthesia are more at risk of developing postoperative negative beha vioral changes compared with children who appear calm during the induction process. Children (n = 91) aged 1-7 yr scheduled for general anesthesia and elective outpatient surgery were recruited. Using validated measures of pr eoperative anxiety and postoperative behaviors, children were evaluated dur ing the induction of general anesthesia and on Postoperative Days 1, 2, 3, 7, and 14. Using a multivariate logistic regression model, in which the dep endent variable was the presence or absence of postoperative negative behav ioral changes and the independent variables included several potential pred ictors, we demonstrated that anxiety of the child, time after surgery, and type of surgical procedure were predictors for postoperative maladaptive be havior. The frequency of negative postoperative behavioral changes decrease d with time after surgery, and the frequency of negative postoperative beha vioral changes increased when the child exhibited increased anxiety during the induction of anesthesia. Finally, we found a significant correlation (r ) of 0.42 (P = 0.004) between the anxiety of the child during induction and the excitement score on arrival to the postanesthesia care unit. We conclu de that children who are anxious during the induction of anesthesia have an increased likelihood of developing postoperative negative behavioral chang es. We recommend that anesthesiologists advise parents of children who are anxious during the induction of anesthesia of the increased likelihood that their children will develop postoperative negative behavioral changes such as nightmares, separation anxiety, and aggression toward authority. Implic ations: Anesthesiologists who care for children who are anxious during the induction of anesthesia should inform parents that these children have an i ncreased likelihood of developing postoperative negative behavioral changes .