Observational study of behavioral disturbance in children with developmental disorder under general anesthesia

Abstract

Abstract Objective Anxiety and fear due to the unknown, and separation from parents are common emotions that children experience when faced with the need for dental treatment. In children with developmental disorders (DD), we hypothesized that a more anxious state, resulting in poor cooperation, might be associated with negative behavioral changes after general anesthesia. In this study, we assessed the perioperative behaviors of children with and without DD. Methods Patients (1–6 yrs) undergoing elective dental treatment were divided into two groups: children with DD and those without DD using inhalational anesthetics such as sevoflurane or isoflurane. The following data were collected prospectively: the modified Yale Preoperative Anxiety Scale (m-YPAS) 1 at the preoperative consultation, m-YPAS 2 at induction of anesthesia, the occurrence of emergence agitation (EA), and the Pediatric Anesthesia Emergence Delirium (PAED). Results The m-YPAS 1 and 2 scores of children with DD were significantly higher than those of children without DD (p<0.05). The occurrence of EA after isoflurane anesthesia in children with and without DD was significantly lower than that after sevoflurane anesthesia (P<0.01). However, after sevoflurane anesthesia, children with DD showed no significant difference in EA compared with children without DD (p=0.13). After isoflurane anesthesia, children with and without DD showed no significant differences (p= 1.00). For both inhalational anesthetics, PAED also showed no significant difference between children with and without DD after sevoflurane anesthesia (p=0.50) and isoflurane anesthesia (p=0.47). Conclusion Isoflurane suppressed EA more effectively than sevoflurane in children. After general anesthesia, however, no significant differences were observed between children, although children with DD showed significant behavioral disturbances. Clinical relevance We provided it was important to pay special attention to children with DD during preoperative and induction of anesthesia. Isoflurane suppressed emergence agitation more effectively. Trial registration This prospective observational study was approved by the Ethics Committee of Kyushu University Hospital (#24034) and registered with the UMIN Clinical Trials Registry (UMIN000034094).