Link Between Preoperative Inflammatory Biomarkers, Anxiety Levels, and Emergence Agitation in Pediatric Patients
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By
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Nezahat Merve Ata Soylu
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Zehra Hatipoglu
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Ersel Gulec
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Mediha Turktan
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Nurefsan Sadıkoglu
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Yusuf Kemal Arslan
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Dilek Ozcengiz
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June 18, 2026
Clinical Scorecard: Link Between Preoperative Inflammatory Biomarkers, Anxiety Levels, and Emergence Agitation in Pediatric Patients
At a Glance
| Category | Detail |
|---|
| Condition | Preoperative Anxiety and Emergence Agitation |
| Key Mechanisms | Neuroinflammatory mediators, HPA axis activation, sympathetic nervous system response, cytokine release. |
| Target Population | Pediatric patients aged 5-12 years scheduled for elective or emergency surgery. |
| Care Setting | Preoperative surgical units. |
Key Highlights
- Preoperative anxiety affects up to 65% of pediatric patients.
- Emergence agitation occurs in 0.25%–90.5% of children post-anesthesia.
- Inflammatory markers such as NLR and SII may indicate neuroinflammatory risk.
- The study included 350 patients with ASA physical status I to II.
- Anxiety levels were assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS).
Guideline-Based Recommendations
Diagnosis
- Assess preoperative anxiety using m-YPAS with a threshold score of ≥ 40.
Management
- Monitor inflammatory markers from hemogram parameters preoperatively.
Monitoring & Follow-up
- Evaluate emergence agitation using the PAED score during the first 30 minutes post-anesthesia.
Risks
- Preoperative anxiety is a risk factor for emergence agitation.
Patient & Prescribing Data
Children aged 5-12 years undergoing surgery.
Consider the role of inflammatory markers in managing preoperative anxiety and emergence agitation.
Clinical Best Practices
- Implement routine assessment of anxiety levels in pediatric patients preoperatively.
- Utilize hemogram-derived inflammatory markers to evaluate neuroinflammatory risk.
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