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PEDIATRIC ANESTHESIOLOGY

Real-Time Assessment of Perioperative Behaviors and Prediction of Perioperative Outcomes

Senthilkumar Sadhasivam, MD, MPH^*, Lindsey L. Cohen, PhD, Alexandra Szabova, MD^*, Anna Varughese, MD^*, Charles Dean Kurth, MD^*, Paul Willging, MD, Yu Wang, MS, Todd G. Nick, PhD, and Joel Gunter, MD^*

From the *Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Department of Psychology, Georgia State University, Atlanta, Georgia; Department of Otorhinolaryngology, and Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Address correspondence and reprint requests to Senthilkumar Sadhasivam, MD, MPH, Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 2001, Cincinnati, OH 45229. Address e-mail to senthilkumar.sadhasivam{at}cchmc.org.

Abstract

Background and Aims: New onset maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, attention-seeking, and fear of being alone are common in children after outpatient surgery. Preoperative anxiety, fear and distress behaviors of children predict postoperative maladaptive behaviors as well as emergence delirium. Parental anxiety has also been found to influence children’s preoperative anxiety. Currently, there is no real-time and feasible tool to effectively measure perioperative behaviors of children and parents. We developed a simple and real-time scale, the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to assess perioperative child and parent behaviors that might predict postoperative problematic behavior and emergence excitement.

METHODS: We used the PACBIS to evaluate perioperative behaviors during anesthetic induction and recovery in a sample of 89 children undergoing tonsillectomies and adenoidectomies, and their parents. Preoperative anxiety with the modified Yale Preoperative Anxiety Scale, compliance with induction of anesthesia with Induction Compliance Checklist, and incidence of emergence excitement were also recorded.

RESULTS: The PACBIS demonstrated good concurrent validity with modified Yale Preoperative Anxiety Scale and Induction Compliance Checklist and predicted postanesthetic emergence excitement.

DISCUSSION: The PACBIS is the first real-time scoring instrument that evaluates children’s and parents’ perioperative behavior. The specific behaviors identified by the PACBIS might provide targets for interventions to improve perioperative experiences and postoperative outcomes.