Postoperative behaviour change in children

Children who undergo surgery under general anaesthesia may subsequently develop changes in their behaviour. These changes can occur acutely during recovery from anaesthesia, or they can be delayed and occur in the days and weeks after surgery. Acute behaviour change is known as emergence delirium and is characterised by a dissociated conscious state where the child is unaware of his or her surroundings. Delayed behaviour change (known as post-hospitalisation behaviour change) is characterised by sleep and eating disorders, temper tantrums, nightmares and anxiety. It has been reported that Post-Hospitalisation Behaviour Change (PHBC) occurs in more than 50 per cent of children undergoing a general anaesthetic. The effect is usually short-lived (two to four weeks), however in 5-10 per cent of children these behaviours can last up to 12 months. The risk factors for developing PHBC include underlying anxiety in the child or parent, a previous bad hospital experience, emergence delirium and pre-school age. PHBC leads to increased general practitioner visits, parental time off work and reduced compliance with future episodes of health care. PHBC after surgery and anaesthesia can be a significant problem for children and parents. The cause of negative behaviour change may be related to the psychological impact of the experience and there may be other pathophysiology directly related to brain changes from the anaesthesia, the stress response to surgery and pain associated with the procedure.