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Minerva Anestesiologica 2018 August;84(8):919-28

DOI: 10.23736/S0375-9393.18.12132-8


lingua: Inglese

Changes in sensory processing after anesthesia in toddlers

Johan M. BERGHMANS 1, 2, 3 , Marten J. POLEY 4, 5, Jan van der ENDE 2, Andre RIETMAN 2, Inge GLAZEMAKERS 6, 7, Dirk HIMPE 1, Frank C. VERHULST 2, 8, Elisabeth UTENS 2, 9

1 Department of Anesthesia, ZNA Middelheim, Queen Paola Children’s Hospital, Antwerp, Belgium; 2 Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Sophia Children’s Hospital, Rotterdam, The Netherlands; 3 Department of Anesthesia, Erasmus MC, Sophia Children’s Hospital, Rotterdam, The Netherlands; 4 Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; 5 Department of Pediatric Surgery, Erasmus MC, Sophia Children’s Hospital, Rotterdam, The Netherlands; 6 Collaborative Antwerp Psychiatric Research Institute, University Antwerp, Antwerp, Belgium; 7 University Center Child and Adolescent Psychiatry, ZNA Middelheim, Antwerp, Belgium; 8 Department of Child and Adolescent Psychiatry, University of Copenhagen, Copenhagen, Denmark; 9 Research Institute of Child Development and Education, University of Amsterdam/de Bascule, Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands

BACKGROUND: Anesthesia and surgery may influence toddlers’ sensory processing and consequently postoperative adjustment and behavior. This is the first study to: 1) test pre- to postoperative changes in sensory processing after pediatric anesthesia using the validated Infant/Toddler-Sensory Profile for 7-36 months (ITSP7-36); 2) identify putative predictors of these changes.
METHODS: This prospective cohort study included 70 healthy boys (ASA I & II), aged 18-30 months, who underwent circumcision for religious reasons. Exclusion: boys with prior surgery and known developmental delay. Primary outcome: changes in sensory processing from the day of admission to day 14 postoperatively. The accompanying parent completed the ITSP7-36. Putative predictors: 1) child’s preoperative emotional/behavioral problems; 2) child’s state anxiety at induction; 3) postoperative pain at home. All children received standardized anesthesia and pain management.
RESULTS: For 45 boys, assessments were completed at both time points. Significant changes in sensory processing (mean ITSP7-36 scores) were found on: low registration (47.5 to 49.8; P=0.015), sensory sensitivity (45.2 to 48.0; P=0.011), sensation avoiding (48.2 to 51.3; P=0.010), low threshold (93.4 to 99.4; P=0.007), auditory processing (39.3 to 43.3; P=0.000) and tactile processing (53.9 to 58.4; P=0.002). Higher scores on emotional/behavioral problems predicted changes on sensory processing.
CONCLUSIONS: Sensory processing of these toddlers had changed after anesthesia. Children with more pre-existent emotional/behavioral problems are more vulnerable to these changes.

KEY WORDS: Anesthesiology - Anxiety - Infant - Postoperative pain - Problem behavior - Sensation

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