Association of preoperative inflammatory markers with preoperative anxiety and agitation in children

Objective: Emergence agitation (EA) is a complication of anesthesia defined as a cognitive state disorder. Neuroinflammation is thought to be the central mechanism in the pathophysiology of RA. Preoperative anxiety can be best explained by the 'acute preoperative stress response.' In this study, we evaluated the relationship between inflammatory markers and ratios obtained from preoperative hemograms in children and the development of preoperative anxiety and EA. Material-method: This single-center, prospective, observational study included 350 pediatric patients aged 5-12 years, ASA I-II. All patients were assessed in the preoperative waiting room using the modified Yale Preoperative Anxiety Scale (m-YPAS). Demographic data, anesthesia/surgical data, and CBC history/parameters were recorded. EA (PAED score) and pain (FLACC <7 years; VAS ≥7 years) were assessed in the recovery room at 0, 5, 10, 20, and 30 minutes. Results: When comparing patients who developed EA (n=130) and those who did not (n=220), those who developed EA had higher leukocyte, monocyte, neutrophil, and platelet counts (p=0.018, 0.005, 0.001, 0.001), lower lymphocyte counts (p=0.042), and higher MLR, NLR, PLR, and Systemic immune inflammatory index (SII) (p<0.001). ROC analysis revealed that SII was the parameter with the highest predictive value for EA. (CBC ≤7 days, AUC:0.713). Regression analysis revealed younger age, postoperative pain, and higher SII as independent risk factors for EA. WBC was higher in children with preoperative anxiety (n=103) (p=0.026). Younger age, anxious parents, and a higher SII were independent predictors of preoperative anxiety. Conclusion: Easily measurable CBC-derived inflammatory markers, particularly SII, can predict the risk of EA in children and guide anesthesiologists in adopting strategies to prevent EA development. Keywords: Anxiety; biomarkers; emergence agitation; inflammation; pediatric.