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PEDIATRIC ANESTHESIOLOGY

Behavioral Analysis of Children’s Response to Induction of Anesthesia

Jill MacLaren Chorney, PhD^*, and Zeev N. Kain, MD, MBA

From the *Department of Anesthesiology, Dalhousie University and the Division of Pediatric Anesthesiology, IWK Health Centre, Halifax, Nova Scotia, Canada; Department of Anesthesiology and Perioperative Care, University of California, Irvine, California; Department of Pediatrics, Children’s Hospital of Orange County, Orange, California; and Department of Psychiatry, Yale University, New Haven, Connecticut.

Address correspondence and reprint requests to Jill MacLaren Chorney, PhD, Centre for Pediatric Pain Research, IWK Health Centre, 8th floor (South), 5850 University Ave., PO Box 9700, Halifax, NS, Canada B3K 6R8. Address e-mail to jemaclaren{at}gmail.com.

Abstract

BACKGROUND: It is documented that children experience distress at anesthesia induction, but little is known about the prevalence of specific behaviors exhibited by children.

METHOD: Digital audiovisual recordings of 293 children undergoing outpatient elective surgery were coded using Observer XT software and the validated Revised Perioperative Child-Adult Medical Procedure Interaction Scale. Multiple pass second-by-second data recording was used to capture children’s behaviors across phases of anesthesia induction.

RESULTS: More than 40% of children aged 2–10 yr displayed some distress behavior during induction with 17% of these children displaying significant distress and more than 30% of children resisting anesthesiologists during induction. Children’s distress and nondistress behaviors displayed four profiles over the course of anesthesia induction: Acute Distress, Anticipatory Distress, Early Regulating Behaviors, and Engagement with Procedure. Older children had higher scores on early regulating and engagement profiles whereas younger children had higher scores on Acute Distress. There were no differences across age in children’s Anticipatory Distress. Construct validity of behavior profiles was supported via correlations of profile score (overall and on the walk to the operating room) with a validated assessment of children’s anxiety at induction.

CONCLUSIONS: Children undergoing anesthesia display a range of distress and nondistress behaviors. A group of behaviors was identified that, when displayed on the walk to the operating room, is associated with less distress at anesthesia induction. These data provide the first examination of potentially regulating behaviors of children, but more detailed sequential analysis is required to validate specific functions of these behaviors.