RESUMEN
Perioperative stress in pediatric patients is often difficult to assess via interviews; thus, an objective measure to assess perioperative stress is needed. To visualize perioperative stress, we observed autonomic nervous system (ANS) activity, circulatory dynamics, and psychological status in pediatric patients undergoing alveolar bone grafting under general anesthesia. This prospective observational study included 40 patients aged 8-12 years who were scheduled for alveolar bone grafting in our hospital. ANS activity was analyzed using heart rate variability the day before surgery, during general anesthesia, 2 h postoperatively, 24 h postoperatively, and the day before discharge. ANS assessment included LF/HF (sympathetic nervous system activity) and HF (parasympathetic nervous system activity). Additionally, heart rate (HR), systolic blood pressure (SBP), face scale (FS) score were recorded. Data from 31 patients, excluding dropouts, were analyzed. The ratio of change to the preoperative value was compared. After surgery, the LF/HF, HR, SBP, and FS score significantly increased (P < 0.01) and HF significantly decreased (2 h postoperatively: P < 0.05, 24 h postoperatively, before discharge: P < 0.01). SBP recovered to preoperative values 24 h postoperatively, and HR and FS scores recovered to preoperative values before discharge. However, even before discharge, LF/HF remained significantly higher than preoperative values, and HF remained significantly lower than preoperative values (P < 0.01). Conclusion We observed perioperative stress from multiple perspectives. Circulatory dynamics and psychological status recovered by the day before discharge; however, ANS activity did not. Therefore, evaluating ANS activity may be useful in visualizing potential perioperative stress in pediatric patients.
RESUMEN
PURPOSE: This study assessed the relationship between changes in autonomic nervous system activity during impacted mandibular third molar extraction and a patient's postoperative psychological status, with the overarching aim of informing the development of interventions to reduce dental phobia and anxiety. We hypothesized that changes in autonomic nervous system activity during tooth extraction are related to postoperative psychology. METHODS: In our prospective cohort study, heart rate variability, heart rate (HR), and systolic blood pressure (SBP) were recorded during impacted mandibular third molar extraction. Heart rate variability values were dichotomized as either low frequency (LF 0.04-0.15 Hz) or high frequency (HF >0.15 Hz). The relative ratios (intraoperative vs baseline) of LF/HF, HF, HR, and SBP were divided into high and low groups based on their median values; the State Anxiety Inventory (STAI-S) results were compared between the groups with high and low relative ratios. RESULTS: Data of 34 female patients (age, 28.23 ± 1.05 years) were analyzed. Postoperative STAI-S values were significantly lower than preoperative values. Patients in the high LF/HF group had a significantly lower change in STAI-S values than those in the low LF/HF group (P < .05). There were no significant differences in the change in STAI-S values between the groups with high and low HF, HR, or SBP. CONCLUSIONS: Patients with low sympathetic nervous system activity had lower anxiety; the LF/HF index was the most sensitive indicator for changes in stress. Additional studies are required to develop optimal interventions for reducing sympathetic nerve activity in patients with dental phobia.