Evaluation of the relationship between vitamin D levels and emerge delirium in children who had tonsillectomy and/or adenoidectomy

Nagehan Ümit Karacan 1, Sinan Yılmaz 2 * , Mustafa Yılmaz 3
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1 Department of Anesthesiology and Reanimation, Faculty of Medicine, Karabuk University Research and Training Hospital, Aydin, Turkey
2 Department of Anesthesiology and Reanimation, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
3 Department of Biochemistry, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 2, pp. 20-25. https://doi.org/10.23950/jcmk/13136
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Background: Pediatric emergence delirium is a general complication of anesthesia with an incidence of 2-80%. Although its etiology is not clearly known, it has been shown that anesthesia method, surgical procedure, and child and parent anxiety may cause the emergence delirium. The relationship between vitamin D levels and emerge delirium in children who underwent tonsillectomy and/or adenoidectomy has not been investigated before
Aim:  In this context, this study was carried out to evaluate the relationship between vitamin D levels and emerge delirium in children who underwent tonsillectomy and/or adenoidectomy.
Material and methods: The study population consisted of children between the ages of 2 and 10, ASA I-II and were scheduled to have elective adenoidectomy and/or tonsillectomy under general anesthesia. All children (n=97) were evaluated for anxiety with the modified Yale Preoperative Anxiety Scale (m-YPAS) before surgery. Children with serum 25(OH)D levels<12 ng/ml and ≥12 ng/ml were categorized as group 1 (n=50) and group 2 (n=47). All children were evaluated for delirium with the Pediatric Anesthesia Emergence Delirium (PAED) scale. The face, legs, activity, cry, consolability (FLACC) scale was used in the evaluation of postoperative pain in children who could not express themselves verbally.
Results: The mean serum 1.25(OH)2D3 level was higher, albeit insignificantly, in group 1 than in group 2. There was no significant difference between the two groups in terms of emerge delirium, preoperative anxiety, postoperative pain and analgesia.
Conclusion: Vitamin D deficiency does not affect the incidence of emergence delirium in children. Vitamin D level does not relate to preoperative anxiety and postoperative pain.


Ümit Karacan N, Yılmaz S, Yılmaz M. Evaluation of the relationship between vitamin D levels and emerge delirium in children who had tonsillectomy and/or adenoidectomy. J CLIN MED KAZ. 2023;20(2):20-5. https://doi.org/10.23950/jcmk/13136


  • Ringblom J, Wåhlin I, Proczkowska M. A psychometric evaluation of the pediatric anesthesia emergence delirium scale. Paediatr Anaesth. 2018;28:332-337. https://doi.org/10.1111/pan.13348
  • Choi EK, Lee S, Kim WJ, Park SJ. Effects of remifentanil maintenance during recovery on emergence delirium in children with sevoflurane anesthesia. Paediatr Anaesth. 2018;28(8):739-44. https://doi.org/10.1111/pan.13446
  • Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab. 2016;85(2):83-106. https://doi.org/10.1159/000443136
  • Velayati A, Vahdat Shariatpanahi M, Dehghan S, Zayeri F, Vahdat Shariatpanahi Z. Vitamin D and postoperative delirium after coronary artery bypass grafting: A prospective cohort study. J. Cardiothorac Vasc Anaesth. 2020;34 (7):1774-1779. https://doi.org/10.1053/j.jvca.2020.02.008
  • Tumer NB, Tekeli Kunt A, Gunaydin S, Ozisik K. Preoperative Vitamin D level is associated with postoperative delirium after cardiac surgery in patients over 65 Years of age. Heart Surg Forum. 2020;23(3):264-269. https://doi.org/10.1532/hsf.2961
  • Torbergsen A, Watne L, Frihagen F, Wyller T, Brugaard A, Mowe M. Vitamin deficiency as a risk factor for delirium. Eur Geriatr Med. 2015;6(4):314-318. https://doi.org/10.1016/j.eurger.2014.09.002
  • Kain ZN, Mayes LC, Cicchetti DV, Caramico LA, Spieker M, Nygren MM, et al. Measurement tool for preoperative anxiety in young children: the Yale Preoperative Anxiety Scale. Child Neuropsychology. 1995; 1(3): 203-210. https://doi.org/10.1080/09297049508400225
  • Hatipoğlu Z, Kirdök O, Özcengiz D. Validity and reliability of the Turkish version of the modified Yale Preoperative Anxiety Scale. Turkish J of Med Sci. 2019;49(3):730-737. https://doi.org/10.3906/sag-1612-113
  • Chang S-W, Lee H-C. Vitamin D and health-The missing vitamin in humans. Pediatrics & Neonatology. 2019;60(3):237-244. https://doi.org/10.1016/j.pedneo.2019.04.007
  • Locatelli BG, Ingelmo PM, Emre S, Meroni V, Minardi C, Frawley G, et al. Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale. Paediatr Anaesth. 2013;23(4):301-8. https://doi.org/10.1111/pan.12038
  • Şenaylı Y, Özkan F, Şenaylı A, Bıçakçı Ü. Evaluation of postoperative pain in children with FLAAC pain scale in Turkish translation. J Anaest Reanim. 2016;4(1):1-4. https://doi.org/10.4274/jcp.2021.0012
  • Ramagopalan SV, Dyment DA, Cader MZ, Morrison KM, Disanto G, Morahan CM, et al. Rare variants in the CYP27B1 gene are associated with multiple sclerosis. Ann Neurol. 2011;70(6):881-886. https://doi.org/10.1002/ana.22678
  • DeGiorgio CM, Hertling D, Curtis A, Murray D, Markovic D. Safety and tolerability of Vitamin D3 5000 IU/day in epilepsy. Epilepsy Behav. 2019;94:195-197. https://doi.org/10.1016/j.yebeh.2019.03.001
  • Zhou R, Wang M, Huang H, Li W, Hu Y, Wu T. Lower vitamin D status is associated with an increased risk of ischemic stroke: a systematic review and meta-analysis. Nutrients. 2018;10(3):277. https://doi.org/10.3390/nu10030277
  • Alpdemir M, Alpdemir MF. Meta analysis Vitamin D deficiency status in Turkey: a meta-analysis. Int J Med Biochem. 2019;2(3);118-131. https://doi.org/10.14744/ijmb.2019.04127
  • Sevil O, Fatih O, Demir O. Association of vitamin D level with age, gender, living place and season of the year in children and adolescents. Journal of Health Sci. 2020;29(2):114-118. https://doi.org/10.34108/eujhs.772031
  • Tellioğlu A, Başaran S. Vitamin D in the light of current knowledge. Archives Med Rev J.2013;22 (2):259-271.
  • Lips P. Relative value of 25(OH)D and 1,25(OH)2D measurements. J Bone Miner Res. 2007;22(11):1668-1671. https://doi.org/10.1359/jbmr.070716
  • Karonova TL, Andreeva AT, Beljaeva OD, Bazhenova EA, Globa PJ, Vasil'eva EJ, et al. Trevozhno-depressivnye rasstroistva u lits s raznym urovnem obespechennosti vitaminom D [Anxiety/depressive disorders and vitamin D status]. Zh Nevrol Psikhiatr Im S S Korsakova. 2015;115(10 Pt 2):55-58. https://doi.org/10.17116/jnevro201511510255-58
  • Han B, Zhu FX, Yu HF, Liu S, Zhou JL. Low serum levels of vitamin D are associated with anxiety in children and adolescents with dialysis. Sci Rep. 2018;8(1):5956. https://doi.org/10.1038/s41598-018-24451-7
  • Vojinovic J. Vitamin D receptor agonists' anti-inflammatory properties. Ann NY Acad Sci. 2014;1317:47-56. https://doi.org/10.1111/nyas.12429
  • Bose S, Khanna A, You J, Arora L, Qavi S, Turan A. Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study. Can J Anaesth. 2015;62(7):770-776. https://doi.org/10.1007/s12630-015-0357-4
  • Kanaya A, Kuratani N, Satoh D, Kurosawa S. Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials. J Anaesth. 2014;28(1):4-11. https://doi.org/10.1007/s00540-013-1656-y
  • Aouad MT, Yazbeck-Karam VG, Nasr VG, El-Khatib MF, Kanazi GE, Bleik JH. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesth. 2007;107(5):733-738. https://doi.org/10.1097/01.anes.0000287009.46896.a7
  • Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651-658. https://doi.org/10.1542/peds.2005-2920
  • Uğur G, Bombacı E, Çevik B. Evaluation of factors affecting emergence agitation in pediatric anesthesia practice. South Clin Istanb Eurasia. 2018;29(1):36-44. https://doi.org/10.14744/scie.2018.28290
  • Kocaturk O, Keles S. Recovery characteristics of total intravenous anesthesia with propofol versus sevoflurane anesthesia: a prospective randomized clinical trial. J of pain Res. 2018;11:1289-1295. https://doi.org/10.2147/JPR.S164106