Questionnaire (Number of Answers Parenthesized)

Appendix 1

Questionnaire (Number of answers parenthesized)

1. Do you consider emergence delirium (ED) as a relevant clinical problem? (check one that applies)?

□Yes

□No

□Free text:_____

2. What kind of medical facility is it that you are working at? (check one that applies)

□Medical practice , 1 procedure room

□Independent ambulant surgery facility

with 2 to 4 OTs

□Primary care hospital

□Secondary care hospital

□Maximum care hospital

□University hospital

□Pediatric hospital

□Other: ______

3. How many children are anesthetized at your facility per week? (check one that applies)

□< 5 □ 5-10

□11-15 □16-20

□>20

4. How many children do you personally anesthetize per week? (check one that applies)

□< 5 □ 5-10

□11-15 □16-20

□>20

5. What is your grade of professional experience in anesthesiology? (check one that applies)

□In training to become a specialist

□1-3 years as a specialist

□3-8 years as a specialist

□more than 8 years as a specialist

□Other: ______

6. How many years of professional experience have you got in pediatric anesthesia? (check one that applies)

□< 1 year □1-3 years

□4-6 years □> 6 years

7. At which department do the surgical interventions mostly take place? (check one that applies)

(All following questions regarding ED should only apply to interventions in this department.)

□Pediatric surgery □General surgery

□Trauma surgery □Urology

□ENT □Ophthalmology

□Odontology □Other:______

8. To which group of age from the before mentioned department do the children predominantly belong? (checkall that apply)

Following questions regarding ED should only apply to this group of age.

□< 1 year □1-2 years

□3-6 years □> 6 years

9. What is the estimated or documented incidence of ED in the children you anesthetize? (check one that applies)?

□< 1% □1 -10%

□11 – 20% □21 – 30%

□> 30%

10. Is your incidence data... (check one that applies)

□Estimated or assumed?

□Documented and analyzed?

□Other: ______

11. Does your information predominantly refer to... (check one that applies)

□Outpatient procedures?

□Inpatient procedures?

□Both?

12. Is ED routinely mentioned to the parents during preanesthetic evaluation at your institution? (check one that applies)?

□Yes

□No

□Depends on the case

□Depends on the anesthetist

13. Is a score used to assess ED (e.g. PAED, Watcha, Cravero)? (check all that apply)

□Yes

□No

□If yes, which one:______

14. Which is your predominant premedication? (check all that apply, indicate dosage)

□Midazolam

□Ketamine

□Clonidine

□Combination of drugs

□Homeopathy

□Other: _____

□No premedication

15. How do you administer premedication routinely? (check one that applies)

□Oral □Rectal

□Intranasal □Intramuscular

□Intravenous □Other: ______

□Not applicable (see previous question)

16. How is general anesthesia routinely induced? (check one that applies)

□IV with propofol □IV with thiopental

□Sevoflurane □Halothane

□Other: ______

17. Does the inhalative induction with sevoflurane lead to a higher incidence of ED from your experience? (check one that applies)

□Yes □No

□I don’t know

18. How is general anesthesia routinely maintained? (check one that applies)

□Isoflurane □Sevoflurane

□Desflurane □Propofol

□Other: ______

19. Which opioid is routinely administered intra-operatively? (check one that applies)

□Fentanyl □Remifentanil

□Alfentanil □Sufentanil

□Other: ______

20. Which preemptive action do you take intraoperatively to avoid a potential ED? (scale between 1st and 5th choice, check all that apply)

TIVA□1. choice …. □5. choice □no usage

Ketamine□1. choice …. □5. choice □no usage

Clonidine□1. choice …. □5. choice □no usage

Dexmedetomidine

□1. choice …. □5. choice □no usage

Other:__□1. choice …. □5. choice □no usage

21. Which substance or combination of substances do you administer in case of ED postoperatively? (scale between 1st and 5th choice, check all that apply)

Propofol □1. choice …. □5. choice □no usage

Ketamine□1. choice …. □5. choice □no usage

Clonidine □1. choice …. □5. choice □no usage

Dexmedetomidine

□1. choice …. □5. choice □no usage

Opioid □1. choice …. □5. choice □no usage

Homeopathy

□1. choice …. □5. choice □no usage

Other: __□1. choice …. □5. choice □no usage

22. How do you rate the effect of these drugs in terms of ED therapy? (scale, check all that apply)

Propofol possible grade per item:

Ketamine□very good = 1

Clonidine□2

Dexmedetomidine□3

Opioids□4

Homeopathy□bad = 5

Other: ______□no experience

23. Where do the children recover directly after general anesthesia has ended? (check one that applies)

□PACU with more than 8 beds

□PACU with 4-8 beds

□PACU with 1-4 beds

□Separate quiet zone

□Ward

□Other: ______

24. Do you think that loudness in the PACU affects ED? (check one that applies, dropdown)?

□No influence □Little influence

□High influence □I don’t know

25. Who works in the PACU? (check one that applies)

□Nursing staff

□Nursing staff specialized in pediatrics

□Nursing staff and doctor

□Other: ______

26. At what stage can a parent or both see the children postoperatively? (check one that applies)

□In the PACU before emergence from GA

□In the PACU after emergence from GA

□On the ward

□Other: ______

27. How do you estimate parental presence postoperatively? (check one that applies, dropdown)

□Counterproductive □Irrelevant

□Important □Very important

□No opinion

28. Which age shows the highest incidence of ED in your opinion? (check one that applies)

□< 1 year □1-2 years

□3-6 years □> 6 years

29. How long does ED last when you see it? (check one that applies)

□< 30 min □31 – 60 min

□61 – 90 min □91 – 120 min

□> 120 min

30. Does one or more of the following factors more likely lead to ED? (check all that apply)

□ED stated in child’s medical history

□ADHD

□Impulsivity

□Low educational background of parents

□High educational background of parents

□Hospitalization or high numbers of previous interventions

□preoperative anxiety

□paradoxical reaction to midazolam

stated in child’s medical history

□Other: ______

31. Does a pre-induction agitated child awake agitated? And does a calm child awake calmly? (check one that applies)

□Yes

□No

□Free text: ____

32. How often does ED lead to an unplanned admission of outpatients to ward? (check one that applies)

□never

□<1%

□1-5%

□6-10%

□11-15%

□>15%

33. Expert opinion: We are interested in your experiences regarding ED. Which facets do you see insufficiently highlighted?

Free text:______