Induction behaviour and race and its association with postoperative agitation in paediatric elective surgery

Abstract

Background: It has been suggested that preoperative agitation in children may be a risk factor for postoperative delirium and postoperative vomiting. Previous studies have suggested that adult African patients have a lower incidence of postoperative nausea and vomiting, but no such association has been shown in children.

Aim: To determine the incidence of both postoperative delirium and postoperative vomiting in elective paediatric surgical patients in a South African hospital and their association with preoperative agitation and patient race.

Methods: A retrospective database analysis was undertaken of patients 1–12 years of age undergoing elective surgery. The Watcha behavioural scale was used to assess pre- and postoperative agitation. A Watcha score > 2 defined significant preoperative agitation or postoperative delirium. Multivariable logistic regression evaluated ENT surgery, sex, age, volatile type, significant preoperative agitation and race as predictors of postoperative delirium. Sex, race, significant preoperative agitation, ENT surgery and vomiting prophylaxis were evaluated as predictors of postoperative vomiting.

Results: Significant preoperative agitation occurred in 13.5% (125/928); postoperative delirium in 3.4% (32/928) and postoperative vomiting in 1.4% (12/856) of patients. Postoperative delirium occurred in 3.1% of African patients as compared with 10.4% of non-African patients (p = 0.007); and postoperative vomiting in 1.2% of African patients as compared with 4.4% of non-African patients (p = 0.074). The predictors of postoperative delirium were non-African race (odds ratio [OR] 3.67; 95% confidence interval [CI] 1.22–11.07; p = 0.021), significant preoperative agitation (OR 3.54; 95% CI 1.55–8.09; p = 0.003), and ENT surgery (OR 2.5; 95% CI 1.0–6.0; p = 0.040). Only non-African race predicted postoperative vomiting (OR 3.73; 95% CI 1.01–13.79; p = 0.049), which included other variables like ENT surgery, significant preoperative anxiety, PONV prophylaxis.

Conclusion: Preoperative agitation, non-African race and ENT surgery were predictors of postoperative agitation. Postoperative vomiting was predicted only by non-African race, which correlates with the trend seen in adults, even though incidence difference between African and non-African patients was not statistically significant.

Keywords: emergence agitation, emergence deliriuminduction behaviour, preoperative agitation, preoperative anxiety