Sleep quality and emergence delirium in children undergoing strabismus surgery: a comparison between preschool- and school-age patients

Wangseok Do, Hyo-Sung Kim, Seung Ha Kim, Hyunjong Kang, Dowon Lee, Jiseok Baik, Hyeon Jeong Lee, Jeong-Min Hong, Wangseok Do, Hyo-Sung Kim, Seung Ha Kim, Hyunjong Kang, Dowon Lee, Jiseok Baik, Hyeon Jeong Lee, Jeong-Min Hong

Abstract

Background: Emergence delirium (ED) is common in pediatric patients undergoing general anesthesia with sevoflurane. Preoperative sleep quality is associated with the risk factors for ED. However, research on the relationship between sleep quality and ED is limited. We aimed to investigate the relationship between ED and preoperative sleep quality in pediatric patients undergoing strabismus surgery.

Methods: This clinical trial included pediatric patients aged 4-12 years who underwent elective strabismus surgery. The patients and their parents were questioned about the patients' preoperative sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For anesthesia induction, thiopental (5 mg/kg) and rocuronium (0.6 mg/kg) were used, and anesthesia was maintained with sevoflurane (minimum alveolar concentration, 1-1.5). After administration of a reversal drug, extubation was performed, and the patients were transferred to a post-anesthesia recovery unit. At 10 min after extubation, the degree of ED was measured using the pediatric anesthesia emergence delirium (PAED) and Watcha scale scores.

Results: Of the 62 enrolled patients, three pediatric patients were excluded. The overall incidence of ED was 22%. A total of 59 patients were divided into the two groups. The ED group and the non-ED group comprised 13 and 46 patients. Age, height and weight were significantly lower in the ED group than in the non-ED group. Preoperative PSQI and Watcha scale score were significantly higher in the ED group than in the non-ED group. Multivariate analysis showed that age (adjusted OR [95% CI]: 0.490 [0.290-0.828], p = 0.008) and preoperative PSQI score (adjusted OR [95% CI]: 2.149[1.224-3.771], p = 0.008) was associated with ED. In sub-group analysis, PAED scale and Watcha scale scores showed a moderate correlation with preoperative sleep quality in preschool-age patients.

Conclusion: In conclusion, the incidence of ED tended to be higher in younger age and poorer preoperative sleep quality in pediatric patients. In particular, the poorer sleep quality score was associated with higher incidence of ED in the preschool-age. Large-scale clinical studies and long-term follow-up studies on ED and sleep quality are required.

Trial registration: This study was registered with Clinicaltrials.gov ( NCT03332407 ) at November 5th 2017.

Keywords: Emergence delirium; Pediatrics; Preoperative sleep quality; Strabismus surgery.

Conflict of interest statement

The authors declare they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Study flow chart. PSQI Pittsburg Sleep Quality Index, ED Emergence delirium

References

    1. Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg. 2007;104(1):84–91. doi: 10.1213/01.ane.0000250914.91881.a8.
    1. Silva LM, Braz LG, Módolo NS. Emergence agitation in pediatric anesthesia: current features. J Pediatr. 2008;84(2):107–113.
    1. Lee SJ, Sung TY. Emergence agitation: current knowledge and unresolved questions. Korean J Anesthesiol. 2020;73(6):471–485. doi: 10.4097/kja.20097.
    1. Lepousé C, Lautner CA, Liu L, Gomis P, Leon A. Emergence delirium in adults in the post-anaesthesia care unit. Br J Anaesth. 2006;96(6):747–753. doi: 10.1093/bja/ael094.
    1. Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth. 2008;18(1):55–59.
    1. Kawai M, Kurata S, Sanuki T, Mishima G, Kiriishi K, Watanabe T, Ozaki-Honda Y, Yoshida M, Okayasu I, Ayuse T, et al. The effect of midazolam administration for the prevention of emergence agitation in pediatric patients with extreme fear and non-cooperation undergoing dental treatment under sevoflurane anesthesia, a double-blind, randomized study. Drug Des Devel Ther. 2019;13:1729–1737. doi: 10.2147/DDDT.S198123.
    1. Demir CY, Yuzkat N. Prevention of emergence agitation with ketamine in rhinoplasty. Aesthet Plast Surg. 2018;42(3):847–853. doi: 10.1007/s00266-018-1103-4.
    1. Sun Y, Li Y, Sun Y, Wang X, Ye H, Yuan X. Dexmedetomidine effect on emergence agitation and delirium in children undergoing laparoscopic hernia repair: a preliminary study. J Int Med Res. 2017;45(3):973–983. doi: 10.1177/0300060517699467.
    1. Luo ZY, Li LL, Wang D, Wang HY, Pei FX, Zhou ZK. Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study. J Orthop Surg Res. 2019;14(1):378. doi: 10.1186/s13018-019-1446-9.
    1. Yang MMH, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019;9(4):e025091. doi: 10.1136/bmjopen-2018-025091.
    1. Wang JP, Lu SF, Guo LN, Ren CG, Zhang ZW. Poor preoperative sleep quality is a risk factor for severe postoperative pain after breast cancer surgery: a prospective cohort study. Medicine (Baltimore) 2019;98(44):e17708. doi: 10.1097/MD.0000000000017708.
    1. Lam EWK, Chung F, Wong J. Sleep-disordered breathing, postoperative delirium, and cognitive impairment. Anesth Analg. 2017;124(5):1626–1635. doi: 10.1213/ANE.0000000000001914.
    1. Leung JM, Sands LP, Newman S, Meckler G, Xie Y, Gay C, Lee K. Preoperative sleep disruption and postoperative delirium. J Clin Sleep Med. 2015;11(8):907–913. doi: 10.5664/jcsm.4944.
    1. Roggenbach J, Klamann M, von Haken R, Bruckner T, Karck M, Hofer S. Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study. Crit Care. 2014;18(5):477. doi: 10.1186/s13054-014-0477-1.
    1. Todd OM, Gelrich L, MacLullich AM, Driessen M, Thomas C, Kreisel SH. Sleep disruption at home as an independent risk factor for postoperative delirium. J Am Geriatr Soc. 2017;65(5):949–957. doi: 10.1111/jgs.14685.
    1. Forbes EE, Bertocci MA, Gregory AM, Ryan ND, Axelson DA, Birmaher B, Dahl RE. Objective sleep in pediatric anxiety disorders and major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2008;47(2):148–155. doi: 10.1097/chi.0b013e31815cd9bc.
    1. Micic G, Lovato N, Gradisar M, Lack LC. Personality differences in patients with delayed sleep-wake phase disorder and non-24-h sleep-wake rhythm disorder relative to healthy sleepers. Sleep Med. 2017;30:128–135. doi: 10.1016/j.sleep.2016.04.002.
    1. Miniksar DY, Özdemir M. Sleep quality in children and adolescents with obsessive-compulsive disorders. Nord J Psychiatry. 2021;75(1):25–30. doi: 10.1080/08039488.2020.1785005.
    1. Sannar EM, Palka T, Beresford C, Peura C, Kaplan D, Verdi M, Siegel M, Kaplan S, Grados M. Sleep problems and their relationship to maladaptive behavior severity in psychiatrically hospitalized children with autism spectrum disorder (ASD) J Autism Dev Disord. 2018;48(11):3720–3726. doi: 10.1007/s10803-017-3362-3.
    1. Van Veen MM, Karsten J, Lancel M. Poor sleep and its relation to impulsivity in patients with antisocial or borderline personality disorders. Behav Med. 2017;43(3):218–226. doi: 10.1080/08964289.2017.1313719.
    1. Gozmen S, Keskin S, Akil I. Enuresis nocturna and sleep quality. Pediatr Nephrol. 2008;23(8):1293–1296. doi: 10.1007/s00467-008-0817-y.
    1. Ayaki M, Torii H, Tsubota K, Negishi K. Decreased sleep quality in high myopia children. Sci Rep. 2016;6:33902. doi: 10.1038/srep33902.
    1. Moturi S, Avis K. Assessment and treatment of common pediatric sleep disorders. Psychiatry (Edgmont) 2010;7(6):24–37.
    1. Wright CE, Schnur JB, Montgomery GH, Bovbjerg DH. Psychological factors associated with poor sleep prior to breast surgery: an exploratory study. Behav Med. 2010;36(3):85–91. doi: 10.1080/08964280903521305.
    1. Bong CL, Ng AS. Evaluation of emergence delirium in Asian children using the pediatric anesthesia emergence delirium scale. Paediatr Anaesth. 2009;19(6):593–600. doi: 10.1111/j.1460-9592.2009.03024.x.
    1. Mason KP. Paediatric emergence delirium: a comprehensive review and interpretation of the literature. Br J Anaesth. 2017;118(3):335–343. doi: 10.1093/bja/aew477.
    1. Stargatt R, Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Jamsen K. A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia. Paediatr Anaesth. 2006;16(8):846–859.
    1. Sadeghi A, Khaleghnejad Tabari A, Mahdavi A, Salarian S, Razavi SS. Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial. Neuropsychiatr Dis Treat. 2017;12:3237–3241. doi: 10.2147/NDT.S119208.
    1. Chundamala J, Wright JG, Kemp SM. An evidence-based review of parental presence during anesthesia induction and parent/child anxiety. Can J Anaesth. 2009;56(1):57–70. doi: 10.1007/s12630-008-9008-3.
    1. Fina DK, Lopas LJ, Stagnone JH, Santucci PR. Parent participation in the postanesthesia care unit: fourteen years of progress at one hospital. J Perianesth Nurs. 1997;12(3):152–162. doi: 10.1016/S1089-9472(97)80033-0.
    1. Mendel HG, Guarnieri KM, Sundt LM, Torjman MC. The effects of ketorolac and fentanyl on postoperative vomiting and analgesic requirements in children undergoing strabismus surgery. Anesth Analg. 1995;80(6):1129–1133.
    1. Munro HM, Riegger LQ, Reynolds PI, Wilton NC, Lewis IH. Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery. Br J Anaesth. 1994;72(6):624–628. doi: 10.1093/bja/72.6.624.

Source: PubMed

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