ABSTRACT
Few children are uncooperative unless they are frightened, distressed or psychologically disturbed. In paediatric anaesthesia, two troublesome behavioural scenarios are common and are associated with each other. First, managing an uncooperative frightened child at induction has always been distressing and tests the social and practical skills of the anaesthesia team. Second, more recently, delayed troublesome postoperative behaviour has been recognised as a problem that is related to distress during induction. It can persist for weeks or longer and sometimes, fortunately rarely, there are more prolonged or permanent psychological effects. Within the last 15 years, much work has helped to assess these problems, to identify children at special risk and to investigate potentially beneficial interventions. The management of uncooperative children should focus on prevention. This chapter explains the extent of behavioural problems related to anaesthesia, how to prevent them and how to manage uncooperative behaviour at induction of anaesthesia.
