Shhh! We’re operating: Quiet ORs lead to better behaviour in kids post-surgery

An operating room (OR) with reduced noise leads to kids behaving better post-surgery. At the recent annual meeting of the American Society of Anesthesiologists (ASA), researchers presented a study comparing the post-surgery behaviour of young children who underwent anesthesia and surgery under normal noise conditions to those in a reduced noise environment. Details were presented in a poster by Nguyen Tram, PhD, an assistant professor of anesthesiology at Ohio State University. The study was part of a larger project investigating various aspects of noise levels in the OR on factors such as adverse events as well as patient well-being. Read: Canadian screening tool could better predict asthma in children: JAMA study “Intraoperative adverse events represent up to 65% of all adverse events in the hospital setting, and the majority of adverse surgical events are due to preventable human factors. One of the major human factors contributing to adverse events is miscommunication, which is often the result of excessive noise in the operating room,” he told the Medical Post. Specifically regarding impact noise might have on children, he noted that previous studies have shown that high noise levels can caused patient distress, increase anxiety, and negatively affect safety and comfort. A total of 33 kids (average age of five years) were randomized to undergo anesthesia and surgery in a noise-reduced operating environment while 31 kids (average age of 4.1 years) who underwent surgery under normal conditions. Surgical procedures included tonsillectomy with or without adenoidectomy, and dental procedures lasting 30 minutes or more. Patients with a history of post-operative delirium were excluded. The reduced noise group had low ambient lighting, muted communication devices and reduced OR personnel. Read: Canadian Paediatric Society releases guidelines for detecting anxiety in kids and youth Behavior was assessed using the Induction Compliance Checklist (ICC) and Modified Yale Preoperative Anxiety Scale (m-YPAS) pre-surgery, and the Post Hospitalization Behavior Questionnaire (PHBQ). The PHBQ was filled out on days one and five post-surgery during phone calls to parents or guardians at home. Results showed no differences between the groups in the ICC and m-YPAS scores. However, PHBQ revealed that children in the reduced noise group were less fussy about eating, more interested in what goes on around them and had fewer temper tantrums in the days following general anesthesia. A second study by researchers from the Mayo Clinic also presented at the ASA found that behaviour problems in kids post-surgery don't last long as it relates to emergence delirium. The study abstract stated that emergence delirium is a common behavioral problem in young children immediately after general anesthesia, with some studies showing behavioral changes even a week after surgery. Here, researchers studied 68 kids age 2.5 to 6 years who underwent general anesthesia for elective surgery. Using the Behavior Assessment System for Children (BASC-3) on both preoperatively (from a week to one day before anesthesia), and three months postoperatively, it was found that 35% had emergence delirium. Follow-up visits showed declines in behaviour problems over time, regardless of whether or not children experienced emergence delirium. Read: Solutions for kids in pain: putting research into practice

Shhh! We’re operating: Quiet ORs lead to better behaviour in kids post-surgery

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