Pediatrik adenotonsillektomi sonrası uyanma deliryumu üzerine preemptif analjezi ve preoperatif anksiyetenin etkileri

Abstract

Amaç: Postoperatif uyanma deliryumu (PED), özellikle çocuklarda anesteziden uyanma sırasında huzursuzluk, yönelim bozukluğu ve ajitasyon ile karakterizedir. Etiyolojisinde preoperatif anksiyete, baş-boyun cerrahisi, inhalasyon ajanları ve ağrı rol oynar. Bu çalışmada, pediatrik adenotonsillektomi sonrası PED üzerine preemptif analjezi ve preoperatif anksiyetenin etkileri araştırılmıştır. Gereç ve Yöntemler: Etik kurul onayı ve yazılı ebeveyn onamı alındıktan sonra 64 pediatrik hasta çalışmaya dahil edildi. Bu prospektif gözlemsel çalışmada hastalar, intravenöz asetaminofen uygulama zamanına göre; cerrahi insizyondan 30 dakika önce (Grup 1) veya cerrahinin bitiminden 15 dakika önce (Grup 2) olacak şekilde sınıflandırıldı. Preoperatif anksiyete modified Yale Preoperative Anxiety Scale (m-YPAS) ile, postoperatif deliryum Pediatric Anesthesia Emergence Delirium (PAED) ölçeği ile ve ağrı Wong-Baker Faces Pain Scale (WBFPS) ile değerlendirildi. Ölçümler postoperatif 0, 5, 10, 15, 30, 45 ve 60. dakikalarda kaydedildi. p<0,05 değeri anlamlı kabul edildi. Bulgular: Gruplar demografik özellik, anestezi süresi, cerrahi geçmiş, ebeveyn memnuniyeti ve komplikasyonlar açısından benzer bulunmuştur. Her iki grupta preoperatif anksiyete yüksekti (m-YPAS ≥30). Grup 1’in ekstübasyon süresi anlamlı olarak daha kısaydı (p<0.001). PAED skorları Grup 1’de 10 dakika, Grup 2’de 15 dakika ≥10 olarak kaldı. PAED ve WBFPS skorları zamanla azalmış ve her iki grupta pozitif korelasyon göstermiştir (p<0.05). Sonuç: Preemptif analjezi postoperatif ağrıyı azaltmış ancak ilk 10 dakikadaki PED skorlarını anlamlı şekilde etkilememiştir. Bulgular, PED’nin önlenmesinde hem anksiyete hem de ağrı yönetiminin birlikte ele alınmasının önemini göstermektedir.

Keywords

• Preemptif analjezi
• Preoperatif anksiyete
• uyanma deliryumu
• pediatrik adenotonsillektomi

Effects of preemptive analgesia and preoperative anxiety on emergence delirium after pediatric adenotonsillectomy

Abstract

Aim: Postoperative emergence delirium (PED) is characterized by restlessness, disorientation, and agitation, particularly in children during emergence from anesthesia. Its etiology includes preoperative anxiety, head-neck surgery, inhalation agents, and pain. This study evaluated the effects of preemptive analgesia and preoperative anxiety on PED after pediatric adenotonsillectomy. Material and Methods: After ethics committee approval and written parental consent were obtained, 64 pediatric patients were enrolled. In this prospective observational study, patients were categorized according to the timing of intravenous acetaminophen administration: 30 minutes before surgical incision(Group 1) or 15 minutes before the end of surgery (Group 2). Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS), postoperative delirium using the Pediatric Anesthesia Emergence Delirium (PAED) scale, and pain using the Wong-Baker Faces Pain Scale (WBFPS). Measurements were recorded at 0, 5, 10, 15, 30, 45, and 60 minutes postoperatively. A p value <0.05 was considered statistically significant. Results: Groups were comparable in demographics, anesthesia time, surgical history, parental satisfaction, and complications. Preoperative anxiety was high in both groups (m-YPAS ≥30). Group 1 had shorter extubation times(p<0.001). PAED scores ≥10 persisted for 10 min in Group 1 and 15 min in Group 2. PAED and WBFPS scores decreased over time, with a positive correlation between them in both groups (p<0.05). Conclusion: Preemptive analgesia reduced postoperative pain but did not significantly affect PED within the first 10 minutes. These findings suggest that managing both anxiety and pain may be necessary to prevent PED in pediatric patients. Further studies are warranted.

Keywords

• Preemptive analgesia
• preoperative anxiety
• emergence delirium
• pediatric adenotonsillectomy

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