Transtorno de adaptação no pós-operatório de crianças e adolescentes

Abstract

Objective: The objective of this study is to verify the Adjustment Disorders (AD) in children undergoing elective surgery and general anesthesia, in the postoperative period and its relationship with the following factors: emotional, behavioral and preoperative somatic symptoms, life events, and type of social security. Subjectsand methods: longitudinal study, observational, with 102 children, ranging from 4 to 13 years of age, associated with public or private health care system, undergoing elective minor surgical procedures under general anesthesia. To detect symptoms of emotional distress in the preoperative period a Strengths and Difficulties Questionnaire (SDQ) was applied. The Coddington Scale and the Post Hospital Behavioral Questionnaire were used as a guide to search for life events and todetect postoperative behavior disorders, respectively. The childrens behaviors were analyzed during anesthetic induction, in the postoperative recovery area and for maladaptive postoperative behaviors for a maximum period of six months after beginning the symptoms. For the sample size, a statistically significant association required a p<5%, power of 80% and 95% confidence intervals. Epiinfo, version 3.2(2004) was used. The X2 or Fisher was used to categorical variables and tocontinuous variables the ANOVA or Kruskal-Wallis tests. Differences showing significant association with AD were then included in a multivariate logistic regression following the stepwise backward procedure. A p-value<0.20 was required for a factor to be retained in the analysis. Results: The prevalence of children with SDQ alterations in the preoperative period was elevated (60.8%). The following variableswere associated with this prevalence: social and economic status, life events, co morbidities and surgical pathologies. The incidence of AD in the samples postoperative period was 52%. Among children with previous symptoms detected by SDQ, 57% developed AD and 36% of the children without previous symptoms developed AD. Postoperative symptoms were present until six months after surgery in 15.7% of the cases. Emotional/behavioral symptoms, possibly related to thesurgical event, appeared early in the preoperative period (9.8%). In the logistic regression analysis, four variables were associated with AD: preoperative life events, undesired postoperative life events, type of health care plan and age. Conclusion: This study confirms the elevated incidence of AD in childrens postoperative period and shows the existence of interaction between the event represented by the surgery with other preoperative variables, such as, SDQ alterations in the preoperative period and experienced life events other than the surgery causing the AD, confirming the importance of multiple factors in its genesis. As original results, this study strongly suggests that the surgical event can bedetermining in the development of early emotional distress in the preoperative period and suggests limitations in the Post Hospital Behavioral Questionnaire, regarding its sensibility to detect symptoms and effects of life events. The continuity of this investigation is recommended, trying to explain the type of interaction betweendetermining life events for the development of AD, the association between the possibility of surgery and the beginning of symptoms, and the creation or improvement of instruments able to detect emotional/behavioral symptoms in the postoperative period.