Inflammatory Biomarkers and Postoperative Delirium in Pediatric Circumcision

Effect of Preoperative Inflammatory Biomarkers on Postoperative Delirium in Children Undergoing Circumcision

Postoperative delirium may occur in children after general anesthesia, even following short procedures such as circumcision. Preoperative systemic inflammation has been associated with postoperative delirium in adults, but data in pediatric patients are limited. This prospective observational study aims to evaluate the association between preoperative inflammatory biomarkers and postoperative delirium in children aged 2-12 years undergoing elective circumcision under general anesthesia. Inflammatory biomarkers derived from routine complete blood count parameters, including NLR, PLR, MLR, SII, and SIRI, will be analyzed. Postoperative delirium will be assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale in the post-anesthesia care unit. The relationship between inflammatory biomarkers and delirium development and severity will be evaluated. This study seeks to identify simple preoperative markers that may help predict postoperative delirium risk in pediatric patients.

Inclusion Criteria:

• Children aged 2-12 years.
• Patients scheduled to undergo elective circumcision under general anesthesia.
• Patients classified as ASA physical status I-II.
• Patients whose parents or legal guardians provide written informed consent, and whose age-appropriate verbal assent is obtained from the child.
• Patients in whom anesthesia and surgical procedures are performed according to standard institutional protocols throughout the study period.

Exclusion Criteria:

• Children with a history of neurological or psychiatric disorders (e.g., epilepsy, developmental delay, autism spectrum disorder, anxiety disorders).
• Patients classified as ASA physical status III-IV.
• Patients with incomplete preoperative laboratory data or with hematological or hormonal disorders that may affect inflammatory parameters.
• Patients who develop excessive sedation after premedication or whose preoperative assessment cannot be completed.
• Patients with protocol deviations during surgery or anesthesia (e.g., additional medications, prolonged surgical duration, or changes in procedure due to complications).
• Patients whose parents or legal guardians do not provide consent or who decline participation.