Co esponding au ho : Hind AbdAlsalam Almaai ah; Email:
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
E alua ion o pa en al sa is ac ion and imp o emen o o al heal h o uncoope a i e
pedia ic pa ien s ea ed unde gene al anes hesia in Queen Alia Mili a y Hospi al
Hind AbdAlsalam Almaai ah *, Alaa Odeh Al Maai a, Heba Ahmad Al a awneh, Amal Taysee Fayez Al-
Kh aisha and Ma am Eid Salman Ba a seh
Depa men o Pedia ic Den al Su ge y, Queen Alia Mili a y Hospi al, Royal Medical Se ices, Jo dan.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
Publica ion his o y: Recei ed on 05 Janua y 2025; e ised on 08 Janua y 2025; accep ed on 09 Janua y 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.21.1.0013
Abs ac
Aim: The s udy explo es pa en al sa is ac ion in paedia ic den is y, examining he impac o p oposed a iables on a
paedia ic coho and hei pa en s, and examining co ela ions be ween ca ego ised a iables and g aded pa en al
sa is ac ion.
Me hods: This s udy is a e ospec i e obse a ional s udy a Queen Alia Mili a y Hospi al, in ol ing 120 pedia ic
pa ien s and hei pa en s om Janua y 2023 o No embe 2024. The pa icipan s we e assessed o ineligibili y o
non-anes he ic p ocedu es and pa en al consen was ob ained. The s udy examined pa en al es ed a iables, including
educa ional le els and pe ip ocedu al communica ion quali y. Pa en al sa is ac ion le els we e classi ied in o h ee
o dinal ca ego ies: poo , good, and excellen . The Den al Sa is ac ion Scale ques ionnai e was used o assess pa en al
sa is ac ion. Chi-squa e analyses we e used o e alua e he dis ibu ional a es ac oss he h ee le els o pa en al
sa is ac ion. Pea son co ela ions we e also examined o examine he s a is ical signi icance o he a ia ion in
sa is ac ion le els.
Resul s: This s udy examined he sa is ac ion le els o pedia ic pa ien s who unde wen den al p ocedu es, ocusing
on ex ac ion only, dual es o a ion wi h exodon ia, o es o a ion wi h pulp he apy. The o e all sa is ac ion a es we e
6 (5%), 39 (32.5%), and 75 (62.5%), espec i ely. The gende dis ibu ion a es we e insigni ican , wi h 62 males
(51.7%) and 58 emales (48.3%) pa icipa ing. The age dis ibu ion a es we e insigni ican , wi h 46.7% o pa ien s
unde 6 yea s a ending es ing. This s udy examined i e p ede ined a iables ela ed o pos -p ocedu al den al
p ocedu es in child en. Fou o hese a iables we e ela ed o he paedia ic coho s, while he i h a iable was he
pa en al in ol emen . All a iables showed signi ican co ela ions ac oss pa en al sa is ac ion le els. The s udy ound
ha pos -p ocedu al ood consump ion, sleep quali y, and ein eg a ion a es in social ac i i ies we e posi i ely
co ela ed wi h pa en al sa is ac ion. Howe e , eco e y ime had a nega i e co ela ion wi h pa en al sa is ac ion. The
s udy also ound a posi i e co ela ion be ween pa en al sa is ac ion and pe iope a i e communica ion be ween he
den al depa men and he pa en al coho o paedia ic pa ien s unde going den al p ocedu es unde anes hesia.
Conclusion: The s udy ound ha comp ehensi e den al ehabili a ion o uncoope a i e child en, along wi h pos -
p ocedu al imp o emen s in o al heal h, sleep quali y, and social ein eg a ion ac i i ies, signi ican ly imp o ed
pa en al sa is ac ion le els and o e all heal hca e sys em quali y.
Keywo ds: Pa en al sa is ac ion; O al Heal h; Uncoope a i e Pedia ic Pa ien s; Anaes hesia ca e; Mul iple logis ic
eg essional modeling
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
156
1. In oduc ion
Paedia ic den al ea men s a e becoming mo e impo an because den al heal h a ec s sys emic heal h in child en.
To imp o e o al heal h, den al diseases mus be ea ed and o al unc ion ebuil [1-3]. Due o se e i y, ea , and anxie y,
many paedia ic pa ien s canno ecei e local anaes hesia den al ea men . T ea men his o y, senso y de ensi eness,
den al ea s, and indi idual di e ences can cause den al anxie y [4-5]. Sys ema ic desensi iza ion, modelling,
ein o cemen , dis ac ion, hypnosis, and he 'TELL show ‘Me hod ha e been sugges ed o manage child en's den al
beha iou [6-7]. Howe e , den al ea and anxie y pe sis , and no all child en espond well o hese me hods. The mos
impo an issue in paedia ic den is y is assessing how ea men me hods con ol ea , anxie y, and coope a ion [8-
9].
Pa en al sa is ac ion is c ucial when assessing den al se ices, especially as pa en s become mo e in ol ed in hei
child en's heal hca e. The a icle "Sa is ac ion o Pa en s and Ca e s wi h Den al T ea men o Child en Unde Gene al
Anaes hesia in a Day Ca e Su ge y Se ing" by Špiljak e al. highligh s he impo ance o be e communica ion abou
ea men p o ocols be o e p ocedu es o educe pa en al anxie y and p omo e collabo a ion be ween ca e s and
heal hca e p o ide s [10-11]. The p e iously men ioned s udy and o he s show ha pa en al sa is ac ion a ec s child
heal h ou comes, sugges ing ha imp o ing pa en al expe iences can imp o e p e en i e ca e adhe ence [12-13]. To
imp o e pa en al sa is ac ion, he se e al au ho s sugges imp o ing communica ion abou ea men p o ocols be o e
p ocedu es o educe pa en al anxie y and encou age ca egi e -p o ide collabo a ion. Anaes hesiologis s a e also
impo an because ins i u ional anaes hesia ca e challenges can a ec pa en al sa is ac ion [14-17].
Add essing hese issues is essen ial o imp o ing paedia ic den al ca e. A good heal hca e sys em imp o es ou comes
and ensu es quali y. Sa is ied pa en s a e mo e likely o bond wi h doc o s, which can imp o e ea men and
p e en ion [18-19]. This shows how mul i ace ed pa en al sa is ac ion is and how i a ec s child en's immedia e and
long- e m heal h [20-21]. Li e a u e e iews concluded ha pa en al sa is ac ion is c ucial o he ea men expe ience
and heal h ou comes o child en unde going gene al anaes hesia den al p ocedu es [22-23]. Heal hca e p o ide s can
imp o e pa en al sa is ac ion and den al heal h engagemen and adhe ence by also add essing ins i u ional issues. The
acili y, lack o in o ma ion, and isks o gene al anaes hesia den al p ocedu es we e hese pa en s' main conce ns [24-
25].
Howe e , se e al p oposed pedia ics and pa en al a iables may p edic pa en al sa is ac ion in paedia ic hospi als,
acco ding o p e ious s udies. This includes he eco e y pe iod a e p ocedu al induc ion and he wai ing pe iod
be o e he den al p ocedu e. Fo paedia ic pa en s, communica ion quali y is c ucial o sa is ac ion. O he a iables
examined include pos ope a i e pain in ensi y, ood consump ion, sleep du a ion, and quali y. Few s udies ha e
compa ed he clinical impac o eimplemen a ion o a ec ed paedia ics social ac i i ies o hei baseline well-heal h.
Pa en al educa ion has also been ex ensi ely s udied [26-29].
This s udy emphasised he need o unde s and and add ess pa en al sa is ac ion in paedia ic den is y. Also, his s udy
examined he impac o a o emen ioned p oposed a iables ela ed o a paedia ic coho and hei pa en s on pa en al
sa is ac ion, anging om poo o excellen . This s udy's seconda y goal is o examine he co ela ions be ween
ca ego ised es ed a iables and g aded pa en al sa is ac ion, adjus ed o s anda d e o s, while abs ac ing he
dis ibu ion a es o he es ed a iable ca ego ies ac oss he h ee pa en al sa is ac ion le els.
2. Me hods
This esea ch is a e ospec i e obse a ional s udy o be conduc ed a Queen Alia Mili a y Hospi al, in ol ing 120
paedia ic pa ien s and hei espec i e pa en s who a ended ou den al speciali y clinics om Janua y 1, 2023, o
No embe 2024. The s udy was conduc ed o e a du a ion o app oxima ely 23 mon hs, wi h inclusion c i e ia
s ipula ing ha uncoope a i e paedia ic pa ien wi h an a e age age o 6 yea s, who equi ed den al ca e deemed
challenging o adminis e in a clinical en i onmen , we e o ecei e gene al anaes hesia. All eligible coho s o
conduc ing his s udy unde wen one o he ollowing p ede ined den al p ocedu es: ex ac ion only, es o a ion
combined wi h exodon ia, o dual es o a ion managemen wi h adjunc i e pulp he apy unde gene al anaes hesia.
This s udy ecei ed app o al om he ins i u ional e iew boa d du ing he commi ee mee ing on Decembe 17, 2024,
and was assigned he egis a ion numbe 24_10/2024. The second and inal app o al o publica ion was ob ained
om ou ins i u ional di ec o a e o echnical and de elopmen a 5 Jan 2025. Due o he e ospec i e design o his
s udy, he in o med consen o m om paedia ic pa en s was wai ed, and he s udy was s ic ly adhe ed o he
s anda ds es ablished in he Helsinki e hical esea ch p o ocols.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
157
The paedia ic coho was comp ised o child en aged 3 o 10 yea s o his s udy, and all pa icipan s we e me iculously
assessed o ineligibili y ega ding non-anes he ic p ocedu es wi h pa en al consen . Any paedia ic pa ien whose
subjec i e assessmen indica ed a high likelihood o ole a ing local anaes he ic echniques and who had medical
condi ions o his o ies ha p ecluded he adminis a ion o one o he h ee a o emen ioned den al p ocedu es unde
gene al anaes hesia, as well as hose wi h a de iciency in assessed and collec ed e ie able da a exceeding 5% o ei he
he paedia ic coho o hei co esponding pa en s, we e excluded om his s udy.
The da a o his s udy was p ima ily ob ained h ough a composi e iad: he documen ed in o ma ion in ou
ins i u ional elec onic eco ding sys em, known as Hakeem; he w i en no es om ou den al clinics depa men ; and
o deba ed o unce ain da a, we add essed hese knowledge gaps by di ec ly con ac ing eligible paedia ic pa en s
using hei eco ded elephone numbe s om ou p i a e a chi es. None heless, he accessible da a encompassed
p ima ily wo dimensions: independen a iables pe aining o he paedia ic pa ien s who unde wen one o he h ee
speci ied den al p ocedu es, and independen a iables ha we e pa ially o exclusi ely ela ed o he pa en s o he
paedia ic coho .
Paedia ic s udies analysed da a p ima ily encompassing demog aphic in o ma ion such as gende and age ca ego ies,
delinea ed as below o abo e he six-yea h eshold. The in es iga ion ocused on he speci ic ypes o den al p ocedu es
pe o med, pos -p ocedu al pain ole abili y, quan i y o ood consump ion ollowing he p ocedu e, and sleep quali y
ela i e o s anda d ca ego ies associa ed wi h poo eco e y. Addi ionally, he ex en o pos -p ocedu al ein eg a ion
in o social ac i i ies and he paedia ic eco e y ime ame ollowing he p ocedu e we e examined.
The independen a iables examined in his s udy, pe aining o he paedia ic coho 's pa en s, e e ed o as pa en al
es ed a iables, p ima ily encompassed hei educa ional le els and he quali y o pe ip ocedu al communica ion.
Howe e , his s udy also add essed he wai ing ime o p ocessing he in ended p ocedu e o b ie ly in es iga e he
impac o delays on pa en al sa is ac ion le els. The p ima y ou comes o his s udy we e he le els o pa en al
sa is ac ion, which we e classi ied in o h ee o dinal ca ego ies: poo sa is ac ion, designa ed as Le el I; good
sa is ac ion, designa ed as Le el II; and excellen sa is ac ion, designa ed as Le el III. I is impo an o no e ha he
ca ego isa ion o he in ol ed pa en s was p ima ily subjec i e and la gely dependen on he pa en s' esponses. The
Den al Sa is ac ion Scale ques ionnai e, a pa en - epo ed ins umen , was p incipally u ilised in his s udy o assess
pa en al sa is ac ion le els abou hei paedia ic pa ien s who unde wen den al p ocedu es unde gene al
anaes hesia.
This s udy employed chi-squa e analyses as he p ima y s a is ical es o e alua e paedia ic and pa en al independen
a iables, ca ego ised as bina y o o dinal. The analysis aimed o elucida e he dis ibu ional a es ac oss he h ee
le els o pa en al sa is ac ion (Le el I-III) by c oss- abula ing he es ed a iable ca ego ies wi h hei co esponding
sa is ac ion le els. Howe e , i is impo an o no e ha he s a is ical signi icance o he a ia ion in hese dis ibu ional
a es was he p ima y ocus o ou s udy. Fu he mo e, he Pea son co ela ions o he assessed a iable ca ego ies
conce ning he a ed pa en al sa is ac ion le els we e examined, wi h hese co ela ions ep esen ed as alues adjus ed
o hei s anda d e o s.
The Mic oso Excel e sion 20 was u ilised in his s udy as he p ima y ool o collec ing, e ising, and il e ing
e ospec i e da a om bo h paedia ic and pa en al sou ces. The S a is ical Package o he Social Sciences (SPSS)
e sion 25 om In el Co po a ion was p ima ily u ilised in his s udy o s a is ically analyse he in ended da a and o
elucida e hei dis ibu ion a es, signi icance, and co ela ion. I is no ewo hy ha he le el o s a is ical signi icance
es ablished in his s udy was se a 5%.
3. Resul s
Paedia ic pa ien s who we e e e ed o ou den al uni a Queen Alia Mili a y Hospi al unde wen one o h ee
speci ied den al p ocedu es: ex ac ion only, dual es o a ion wi h exodon ia, o es o a ion wi h pulp he apy. The
o e all pa en al sa is ac ion a es in his s udy, ca ego ised in o h ee le els—poo sa is ac ion (Le el I), good
sa is ac ion (Le el II), and excellen sa is ac ion (Le el III)—we e de e mined as 6 (5%), 39 (32.5%), and 75 (62.5%),
espec i ely. No ably, his s udy did no demons a e s a is ical signi icance conce ning he h ee a o emen ioned
den al p ocedu es (p- alue=0.473). In his s udy, app oxima ely 5% (6 cases) o he paedia ic coho unde wen
ex ac ion only. App oxima ely 89.2% (107 cases) we e pe o med o dual es o a ion wi h exodon ia, while abou
5.8% (7 cases) we e conduc ed o es o a ion managemen in ol ing pulp he apy.
The gende dis ibu ion a es among he h ee le els o pa en al sa is ac ion exhibi ed s a is ically insigni ican
a ia ion (p- alue=0.248), wi h a o al o 62 males (51.7%) and 58 emales (48.3%) pa icipa ing in his s udy. The age
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
158
dis ibu ion a es ac oss sa is ac ion le els I-III we e s a is ically insigni ican (p- alue=0.750) when he paedia ic
p ocedu al anaes hesia was ca ego ised in o wo age g oups: unde 6 yea s and o e 6 yea s. No ably, he pe cen age
o paedia ic pa ien s unde 6 yea s o age who a ended es ing was 46.7% (56 cases), while hose o e 6 yea s
cons i u ed 53.3% (64 cases).
This s udy e eals a s a is ically signi ican co ela ion be ween pa en al educa ion le els and pa en al sa is ac ion. The
educa ion le els anged om he lowes ca ego y o high school o he highes , including mas e 's deg ees and beyond.
The dis ibu ion ac oss he h ee pa en al sa is ac ion le els was s a is ically signi ican (p- alue=0.024), wi h
app oxima ely 43.3% (52 cases) a he high school le el, 39.2% (47 cases) a he bachelo 's deg ee le el, and 17.5% (21
cases) a he mas e 's deg ee o highe le el. Ini ially, when conduc ed a chi-squa e analysis o examine he pa en al
educa ional le els ac oss he h ee p ima y in es iga ed pa en al sa is ac ion le els. The highes a e o excellen
pa en al sa is ac ion was obse ed in he high school educa ional ca ego y (37 (49.3%)), while he good pa en al
sa is ac ion le el was no ed among pa en s wi h bachelo 's deg ees (22 (56.4%)). The highes a e o poo pa en al
sa is ac ion was obse ed among pa en s wi h a mas e 's deg ee o highe , comp ising 3 indi iduals (50.0%) o he
s udied coho . The Pea son co ela ion indica ed a weak bu s a is ically signi ican nega i e co ela ion be ween he
inc ease in pa en al educa ional le els and he enhancemen o pa en al sa is ac ion le els [-0.119±0.099]. The esul s
o c oss- abula ion analyses ega ding paedia ic demog aphic and p ocedu al speci ica ions, along wi h pa en al
educa ional le els a e ully exp essed below in Table 1.
Table 1 Resul s o c oss- abula ion analyses ega ding paedia ic demog aphic and p ocedu al speci ica ions, along
wi h pa en al educa ional le els
Sa is ac ion le els
R±SEV
Sig
Le el I
Le el II
Le el III
Le el I-III
(6, 5%)
(39, 32.5%)
(75, 62.5%)
120
Gende
F
2 (33.3%)
17 (43.6%)
43 (57.3%)
62 (51.7%)
-0.152±0.089
0.248
M
4 (66.7%)
22 (56.4%)
32 (42.7%)
58 (48.3%)
Age (Y s)
<6
3 (50.0%)
20 (51.3%)
33 (44.0%)
56 (46.7%)
+0.063±.091
0.750
≥6
3 (50.0%)
19 (48.7%)
42 (56.0%)
64 (53.3%)
Den al TRT
Ex ac ion only
1 (16.7%)
2 (5.1%)
3 (4.0%)
6 (5.0%)
+0.148±0.089
0.473
Res o a ion w Exo
5 (83.3%)
36 (92.3%
66 (88.0%)
107 (89.2%)
Res o a ion w Pulp
0 (0.0%)
1 (2.6%)
6 (8.0%)
7 (5.8%)
Educa ional Le el
High school
2 (33.3%)
13 (33.3%)
37 (49.3%)
52 (43.3%)
-0.119±0.099
0.024
Bachelo
1 (16.7%)
22 (56.4%)
24 (32.0%)
47 (39.2%)
Mas e o highe
3 (50.0%)
4 (10.3%)
14 (18.7%)
21 (17.5%)
Chi-squa e analyses we e pe o med in his s udy o examine he a ia ions in dis ibu ion a es o he a o emen ioned independen a iables
ac oss he h ee le els o pa en al sa is ac ion: Poo sa is ac ion le el (Le el I), Good sa is ac ion le el (Le el II), and Excellen sa is ac ion le el
(Le el III). Fu he mo e, he Pea son co ela ions we e also ex ac ed in hese conduc ed c oss- abula ion analyses. The h eshold o s a is ical
signi icance in his s udy was es ablished a 5%.
• R: Pea son co ela ion.
• SEV: S anda d e o o alue.
• Sig: S a is ically signi ican .
• F: Female.
• M” Male. Y s: Yea s.
• TRT: T ea men .
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
159
• EXO: Exodon ia o exodon ics.
In his s udy, we e alua ed i e p ede ined a iables, ou o which pe ained o he paedia ic coho s unde
in es iga ion: pos -p ocedu al ood quan i y consump ion, o e all quali y o pos -p ocedu al sleep, du a ion o pos -
p ocedu al eco e y pe iods in days, and he esump ion o social ac i i ies pos -p ocedu e. The i h es ed
independen a iable pe ained o he pa en al in ol emen o he paedia ic coho , a icula ed as he quali y o
pe ip ocedu al communica ion. All i e p ede ined independen a iables demons a ed s a is ical signi icance when
we assessed hei dis ibu ional a e a iances ac oss he h ee examined le els o pa en al sa is ac ion (Le el I-III).
None heless, he pos p ocedu al ood consump ion a e, pos p ocedu al sleep quali y, and pos p ocedu al
ein eg a ion a es in social ac i i ies exhibi ed s a is ically signi ican mild o mode a e posi i e Pea son co ela ions
[+0.400±0.118, +0.441±0.104, and +0.199±0.092, espec i ely]. The pos p ocedu al es o a ion o s anda d ood in ake,
sleep quali y, and social engagemen exhibi ed he highes dis ibu ion a es [70 (93.3%), 74 (98.7%), and 70 (93.3%),
espec i ely] in he excellen pa en al sa is ac ion le el (Le el III), in con as o he lowe dis ibu ion a es [0 (0.0%),
2 (33.3%), and 5 (83.3%), espec i ely] obse ed in he poo pa en al sa is ac ion le el (Le el I).
In con as o h ee associa ed paedia ic independen a iables, he eco e y ime, also designa ed as an independen
a iable pe inen o he examined paedia ic coho , exhibi ed a mild s a is ically signi ican nega i e Pea son
co ela ion [-0.247±0.104] conce ning he p og ession o he eco e y pe iod in ela ion o he enhancemen o pa en al
sa is ac ion le els. In ins ances, he dis ibu ion a es o high pa en al sa is ac ion (Le el III) demons a ed
app oxima ely 62.7% (47 cases) when he pos ope a i e eco e y pe iod did no exceed 2 days; con e sely, he a es
declined o app oxima ely 5.3% (4 cases) when he eco e y pe iod exceeded 7 days o he paedia ic pa ien s ea ed.
This s udy p ima ily aimed o in es iga e he ole o pe iope a i e communica ion be ween he den al depa men o
ou ins i u ion and he pa en al coho o paedia ic pa ien s unde going one o h ee speci ied den al p ocedu es unde
anaes hesia. We ound a s a is ically signi ican mild posi i e Pea son co ela ion [+0.248±0.097], indica ing ha all
pa en s who epo ed an excellen le el o sa is ac ion desc ibed high le els o communica ion du ing he pe iope a i e
p ocesses wi h he den al ca e acili y. None heless, he esul s o c oss- abula ion analyses ega ding pos -p ocedu al
pain, ood quan i y, and sleep quali y, in addi ion o p e-p ocedu al wai ing and pos -p ocedu al eco e y imes, as well
as pe iope a i e communica ion pa e ns, a e comp ehensi ely p esen ed below in Table 2.
Fu he mo e, Figu e 1 ea u es a 3D illus a ion ha consolida es he majo i y o ou ou comes o in e es . The
es ablished pa en al sa is ac ion le els a ied om poo sa is ac ion (Le el I) o good sa is ac ion (Le el II) and
excellen sa is ac ion (Le el III), while accoun ing o he no able e ec o e alua ed paedia ic eco e y du a ions in
days: up o 2 days, 3-7 days, and exceeding 7 days, alongside he impac o pe iope a i e communica ion quali y,
classi ied as in e mi en (Blue) e sus egula (Red).
Table 2 Ou comes o c oss- abula ion analyses conce ning pos -p ocedu al pain, ood quan i y and sleep quali y, along
wi h p ep ocedu al wai ing and pos p ocedu al eco e y imes, as well as pe iope a i e communica ion pa e ns
Sa is ac ion le els
R±SEV
Sig
Le el I
Le el II
Le el III
Le el I-III
(6, 5%)
(39, 32.5%)
(75, 62.5%)
120
Pos -P ocedu al Pain
Tole able
4 (66.7%)
29 (74.4%)
56 (74.7%)
89 (74.2%)
-0.027±0.094
0.911
In ole able
2 (33.3%)
10 (25.6%)
19 (25.3%)
31 (25.8%)
Pos -P ocedu al Food Q y
Poo
6 (100.0%)
3 (7.7%)
5 (6.7%)
14 (11.7%)
+0.400±0.118
0.000
S anda d
0 (0.0%)
36 (92.3%)
70 (93.3%)
106 (88.3%)
Pos -P ocedu al Sleep Qly
Poo
4 (66.7%)
4 (10.3%)
1 (1.3%)
9 (7.5%)
+0.441±0.104
0.000
S anda d
2 (33.3%)
35 (89.7%)
74 (98.7%)
111 (92.5%)
Wai ing Time (Mon hs)
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<3
3 (50.0%)
24 (61.5%)
48 (64.0%)
75 (62.5%)
-0.100±0.100
0.608
3-6
1 (16.7%)
9 (23.1%)
19 (25.3%)
29 (24.2%)
>6-9
2 (33.3%)
6 (15.4%)
8 (10.7%)
16 (13.3%)
Reco e y Pe iod (Days)
≤2
2 (33.3%)
18 (46.2%)
47 (62.7%)
67 (55.8%)
-0.247±0.104
0.002
3-7
1 (16.7%)
18 (46.2%)
24 (32.0%)
43 (35.8%)
>7
3 (50.0%)
3 (7.7%)
4 (5.3%)
10 (8.3%)
Social ac i i y
Res ic ed
1 (16.7%)
9 (23.1%)
5 (6.7%)
15 (12.5%)
+0.199±0.092
0.040
As Usual
5 (83.3%)
30 (76.9%)
70 (93.3%)
105 (87.5%)
Pe i-P ocedu al In e ac ions
Limi ed
1 (16.7%)
2 (5.1%)
0 (0.0%)
3 (2.5%)
+0.248±0.097
0.019
Regula
5 (83.3%)
37 (94.9%)
75 (100.0%)
117 (97.5%)
Chi-squa e analyses we e pe o med in his s udy o examine he a ia ions in dis ibu ion a es o he a o emen ioned independen a iables
ac oss he h ee le els o pa en al sa is ac ion: Poo sa is ac ion le el (Le el I), Good sa is ac ion le el (Le el II), and Excellen sa is ac ion le el
(Le el III). Fu he mo e, he Pea son co ela ions we e also ex ac ed in hese conduc ed c oss- abula ion analyses. The h eshold o s a is ical
signi icance in his s udy was es ablished a 5%.
• R: Pea son co ela ion.
• SEV: S anda d e o o alue.
• Sig: S a is ically signi ican .
• Qly: Quali y.
• Q y: Quan i y.
Figu e 1 A 3D illus a ion ha compiles he majo i y o ou ou comes o in e es . The p ede ined pa en al sa is ac ion
le els anged om poo sa is ac ion (Le el I) o good sa is ac ion (Le el II) and excellen sa is ac ion (Le el III), while
conside ing he signi ican impac o he assessed paedia ic eco e y imes in days: up o 2 days, 3-7 days, and o e 7
days, as well as he in luence o pe iope a i e communica ion quali y, ca ego ised as in e mi en (Blue) e sus
egula (Red)
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
161
4. Discussion
This s udy was conduc ed a he Queen Alia Mili a y Hospi al in Amman, Jo dan, wi hin ou ins i u ional den al
depa men o paedia ics, ocussing on o al heal h ca e o paedia ic pa ien s h ough one o he p ede ined den al
p ocedu es: ex ac ion only, es o a ion managemen wi h exodon ia, o es o a ion managemen wi h pulp he apy,
all unde gene al anaes hesia. This s udy p ima ily aimed o assess he s a is ical signi icance o a ious p ede ined
independen a iables associa ed wi h bo h he es ed paedia ic subjec s and hei espec i e pa en s, in ela ion o
he ou comes conce ning pa en al sa is ac ion le els—ca ego ized as poo , good, o excellen —while conside ing he
adjus ed Pea son co ela ion and i s s anda d e o s. None heless, he assessed p edic i e a iables o pa en al
sa is ac ion, as p e iously ou lined, encompass p ima ily he ex en and quali y o pe iope a i e communica ion,
pos p ocedu al eco e y du a ions, and o he pe inen paedia ic pos p ocedu al enhancemen s in speci ic moni o ed
me ics o ood in ake and sleep quali y, as well as ein eg a ion in o cus oma y social ac i i ies.
This s udy concluded ha a ious in es iga ed a iables may conside ably a ec pa en al sa is ac ion le els in bo h
posi i e and nega i e di ec ions, and hese po en ial independen a iables may pe ain o bo h he es ed paedia ic
subjec s and hei pa en s. I is no ewo hy ha all pa icipan s in his s udy had den al p ocedu es unde gene al
anaes hesia due o he challenges associa ed wi h pe o ming hese p ocedu es using local anaes hesia. Ou s udy
shown ha he pos p ocedu al eco e y du a ion signi ican ly in luenced pa en al sa is ac ion compa ed o he
p ep ocedu al wai ing pe iod. This s udy ca ego izes he p ep ocedu al wai ing ime pe iod in o h ee classi ica ions:
less han 3 mon hs, 3 o 6 mon hs, and g ea e han 6 mon hs. Ele a ed le els o pa en al sa is ac ion we e seen o he
p ocedu e, wi h he majo i y o pa en s con en wi h he quali y o in o ma ion and communica ion wi h p o essionals
du ing he pe iope a i e pe iod. The subjec s examined encompassed ca e sa is ac ion egis a ion, a e ca e o al
hygiene and die a y ecommenda ions, and ad e se e en s eco ded in ins ances o mul iple egis a ions, whe ein he
majo i y o pa en s a icula ed app ehensions ega ding he po en ial isks o gene al anaes hesia o hei child en.
A es ic ed se o a iables was ecognised as signi ican in p e ious paedia ic hospi al s udies in es iga ing pa en al
sa is ac ion ega ding mul idimensional ac o s ela ed o paedia ic p ocedu al den is y, wi h o wi hou he
associa ed pa en al in luences on o e all sa is ac ion, imp essions, and pe cep ions [30-34]. Se e al con ex ual
cha ac e is ics associa ed wi h he e alua ed paedia ic pa en s may o ecas hei pleasu e. Among he p oposed
independen a iables a e he du a ion o he ecupe a ion pe iod ollowing p ocedu al induc ion and he wai ing
pe iod be o e pe o ming he in ended den al ea men [35-37].
A s udy conduc ed by Ma hew MG e al. in ol ed 200 child en who unde wen ull-mou h ehabili a ion unde gene al
anaes hesia o he managemen o ea ly childhood ca ies. The esul s indica ed a no able enhancemen in o al heal h-
ela ed quali y o li e and pa en al con en men . Pa en s indica ed a ou able pe cei ed esul s and a no able
enhancemen in hei child's o al and o e all heal h. The esea ch de e mined ha he in e en ion ul illed he pa en s'
expec a ions [38]. In ou s udy, we iden i ied a nega i e link be ween he p og ession o he eco e y pe iod and
pa en al sa is ac ion le els, wi h ele a ed sa is ac ion a es in paedia ic pa ien s (62.7%) obse ed when he eco e y
du a ion was unde 2 days. In a sepa a e s udy examining he in luence o wai ing pe iods on pa en al sa is ac ion,
Sa gın M e al. u ilised he Paedia ic Anaes hesia Pa en Sa is ac ion (PAPS) su ey o compa e pa en al sa is ac ion
be ween wo g oups o child en, one wi h de elopmen al delays and he o he wi hou . The esul s indica ed no
subs an ial dispa i y in sa is ac ion among he g oups, wi h he excep ion o he lowes sco e eco ded in he "Be o e
anaes hesia" segmen . The esea ch e ealed ha pa en al sa is ac ion is equi alen o child en wi h de elopmen al
delays and hose wi hou [39]. In ou s udy, which emphasised he wai ing and delay pe iods in mon hs p io o he
p ocedu e, we did no unco e a s a is ically signi ican co ela ion be ween wai ing leng hs and pa en al sa is ac ion
le els. A s udy conduc ed by Ka aca S e al., comp ising 214 child en wi h se e e ea ly childhood ca ies unde gene al
anaes hesia, shown ha comp ehensi e den al ehabili a ion unde gene al anaes hesia d ama ically enhanced hei
physical and social quali y o li e. o examine he signi ican enhancemen o o al heal h, unc ionali y, and social ac i i y
ollowing p ocedu e implemen a ion, The s udy assessed pa ien s' o al complain s, unc ional limi s, emo ional and
social ci cums ances, and pa en al sa is ac ion p io o and 18 mon hs pos - ea men . The indings indica ed a
subs an ial educ ion in symp oms and unc ional impai men s pos - ea men , accompanied by a high pa en al
sa is ac ion sco e o 98.14%. This indica es ha o al ehabili a ion can ma kedly enhance he quali y o li e o child en
and hei amilies [40]. We simila ly e ealed a s a is ically signi ican pos p ocedu al enhancemen in ood quali y, also
e e ed o as o al heal h quali y, as well as imp o emen s in sleep quali y and social ein eg a ion ac i i ies in ela ion
o pa en al sa is ac ion le els.
Mo eo e , a signi ican elemen in luencing paedia ic pa en s' sa is ac ion le els pe ains o he quali y o
communica ion [41-42]. Few p io esea ch ha e ocused on examining he he apeu ic e ec s o pa en al educa ional
le els, which ha e a iably in luenced pa en al sa is ac ion [43-45]. Ou s udy, howe e , demons a ed a s a is ically
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
162
signi ican di e ence among he a ious pa en al educa ional le els, anging om high school o mas e 's deg ee and
beyond. In equen ly add essed and unde app ecia ed a iables, such as den al p o essionalism, signi ican ly a ec
pa en al sa is ac ion. P io esea ch indica es ha pa en s' assessmen s o hei child's den al ea men unde gene al
anaes hesia may be in luenced by he conduc o den al p o essionals and hei child en. Reg e ably, we did no
examine he signi ican signi icance o den al s a p o essionalism in ela ion o pa en al sa is ac ion le els. This s udy
was limi ed by i s e ospec i e design, single cen e, ela i ely small sample size, and es ic ed es ed ac o s, which
hinde ed ou abili y o conduc mo e ad anced eg ession analysis o explo e he co ela ions wi h he adjus ed
p opensi y a ios. Fu he p ospec i e mul icen e andomised s udies wi h la ge sample sizes a e s ongly
ecommended o conduc esea ch simula ing pa en al sa is ac ion, aiming o iden i y s onge p edic o s o pa en al
sa is ac ion and o explo e causali y a he han me e associa ions [46-48].
5. Conclusion
This s udy demons a ed ha comp ehensi e den al ehabili a ion unde gene al anaes hesia o uncoope a i e
child en, accompanied by paedia ic pos p ocedu al enhancemen s in o al heal h, sleep quali y, and social ein eg a ion
ac i i ies, signi ican ly impac ed pa en al sa is ac ion le els and consequen ly imp o ed he o e all quali y o he
heal hca e sys em. Fu he mo e, bo h he pos ope a i e eco e y du a ion and he ex en o p eope a i e
communica ion shown a s a is ically signi ican impac on pa en al sa is ac ion le els in his s udy. This s udy ound a
s a is ically signi ican , albei weak, un a ou able associa ion be ween g ea e pa en al educa ional le els and hei
endency o sa is ac ion. We did no iden i y a signi ican co ela ion be ween wai ing pe iods and pa en al sa is ac ion
le els. Howe e , conside ing he p e iously men ioned signi ican paedia ic and pa en al a iables may in luence he
likelihood o achie ing g ea e pa en al sa is ac ion and, consequen ly, an enhanced o e all quali y o he heal hca e
sys em.
Compliance wi h e hical s anda ds
Acknowledgemen
Ou app ecia ion goes o s a o he depa men o Queen Alia Mili a y Hospi al o hei eno mous assis ance and
ad ice.
Disclosu e o con lic o in e es
The e is no con lic o in e es in his manusc ip
S a emen o e hical app o al
The e is no animal subjec in ol emen in his manusc ip . This s udy ecei ed app o al om he ins i u ional e iew
boa d du ing he commi ee mee ing on Decembe 17, 2024, and was assigned he egis a ion numbe 24_10/2024.
The second and inal app o al o publica ion was ob ained om ou ins i u ional di ec o a e o echnical and
de elopmen a 5 Jan 2025. Due o he e ospec i e design o his s udy, he in o med consen o m om paedia ic
pa en s was wai ed, and he s udy was s ic ly adhe ed o he s anda ds es ablished in he Helsinki e hical esea ch
p o ocols.
S a emen o in o med consen
Owing o he e ospec i e design o his s udy, he in o med consen o m was wai ed.
Re e ences
[1] Aghababaie ST, Mon ei o J, S a igaki E, Ashley PF. Techniques o e ec i e local anaes he ic adminis a ion o
he paedia ic pa ien . B i ish Den al Jou nal. 2020 Dec;229(12):779-85.
[2] Ho JP, an Rie TC, A ian Y, Sem KT, Spijke R, de Lange J, Lindeboom JA. Ad e se e ec s ollowing den al local
anes hesia: a li e a u e e iew. Jou nal o den al anes hesia and pain medicine. 2021 Dec;21(6):507.
[3] Ezzeldin M, Hanks G, Colla d M. Uni ed Kingdom pedia ic den is y specialis iews on he adminis a ion o
a icaine in child en. Jou nal o den al anes hesia and pain medicine. 2020 Oc ;20(5):303.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 155-165
163
[4] Akl N, Somme ield A, Sle in L, D ake-B ockman TF, Wong S, Win e s JC, Unge n-S e nbe g BS, Somme ield D.
Anaes hesia, pain and eco e y p o iles in child en ollowing den al ex ac ions. Anaes hesia and In ensi e Ca e.
2020 Jul;48(4):306-13.
[5] Uça G, Şe me Elbay Ü, Elbay M. E ec s o low le el lase he apy on injec ion pain and anes hesia e icacy du ing
local anes hesia in child en: a andomized clinical ial. In e na ional Jou nal o Paedia ic Den is y. 2022
Jul;32(4):576-84.
[6] Rod igues VB, Cos a LR, Co êa de Fa ia P. Pa en s’ sa is ac ion wi h paedia ic den al ea men unde seda ion:
A c oss‐sec ional s udy. In e na ional Jou nal o Paedia ic Den is y. 2021 May;31(3):337-43.
[7] Admass BA, Hailema iam AS, Agegnehu AF, Ge ahun AB. Pa en al sa is ac ion and associa ed ac o s owa d hei
child's anes hesia se ice a a comp ehensi e specialized e e al hospi al in E hiopia, 2021: a c oss-sec ional
s udy. F on ie s in Pedia ics. 2022 Jun 6;10:849969.
[8] Öz ü k G, Gümüş H. E alua ion o o al heal h‐ ela ed quali y o li e ollowing den al ehabili a ion unde gene al
anes hesia in Tu kish child en wi h ea ly childhood ca ies. In e na ional Jou nal o Paedia ic Den is y. 2024
Jan;34(1):47-57.
[9] McIn y e RS, Alda M, Baldessa ini RJ, Baue M, Be k M, Co ell CU, Fagiolini A, Foun oulakis K, F ye MA, G unze
H, Kessing LV. The clinical cha ac e iza ion o he adul pa ien wi h bipola diso de aimed a pe sonaliza ion o
managemen . Wo ld Psychia y. 2022 Oc ;21(3):364-87.
[10] Riegel B, Wes land H, Io ino P, Ba elds I, Slo JB, S awnychy MA, Osokpo O, Ta bi E, T appenbu g JC, Vellone E,
S ömbe g A. Cha ac e is ics o sel -ca e in e en ions o pa ien s wi h a ch onic condi ion: A scoping e iew.
In e na ional jou nal o nu sing s udies. 2021 Ap 1;116:103713.
[11] Simone i A, Pais C, Jones M, Cip iani MC, Jani i D, Mon i L, Landi F, Be nabei R, Lipe o i R, Sani G.
Neu opsychia ic symp oms in elde ly wi h demen ia du ing COVID-19 pandemic: de ini ion, ea men , and
u u e di ec ions. F on ie s in psychia y. 2020 Sep 29;11:579842.
[12] Sabbagh HJ, Sijini OT. Pa en al p e e ence o pa en al sepa a ion and hei sa is ac ion ega ding hei child en
den al ea men in pedia ic den al clinics in Saudi A abia. Jou nal o In e na ional Socie y o P e en i e and
Communi y Den is y. 2020 Jan 1;10(1):116-23.
[13] S ensson M, No de yd J, Van Ripe M, Ma ks L, Bjö k M. Pa en s’ pe cep ions o o al heal h, gene al heal h and
den al heal h ca e o child en wi h Down synd ome in Sweden. Ac a Odon ologica Scandina ica. 2021 May
19;79(4):248-55.
[14] Passos De Luca M, Massignan C, Bolan M, Bu ini Oli ei a L, Aydinoz S, Dick B, De Luca Can o G. Does he p esence
o pa en s in he den al ope a o y oom in luence child en’s beha iou , anxie y and ea du ing hei den al
ea men ? A sys ema ic e iew. In e na ional Jou nal o Paedia ic Den is y. 2021 May;31(3):318-36.
[15] Ma hew MG, Roopa KB, Soni AJ, Khan MM, Kause A. E alua ion o clinical success, pa en al and child sa is ac ion
o s ainless s eel c owns and zi conia c owns in p ima y mola s. Jou nal o Family Medicine and P ima y Ca e.
2020 Ma 1;9(3):1418-23.
[16] Fe azzano GF, Sale no C, Sangianan oni G, Ca uso S, Ingeni o A, Can ile T. The e ec o den al ea men unde
gene al anes hesia on quali y o li e and g ow h and blood chemis y pa ame e s in uncoope a i e pedia ic
pa ien s wi h comp omised o al heal h: a pilo s udy. In e na ional jou nal o en i onmen al esea ch and public
heal h. 2020 Jun;17(12):4407.
[17] Schulz-Weidne N, Schlenz MA, Jung LG, Uebe eck CF, Nehls A, K äme N. Den al ea men unde gene al
anes hesia in p e-school child en and schoolchild en wi h special heal hca e needs: a compa a i e e ospec i e
s udy. Jou nal o Clinical Medicine. 2022 May 6;11(9):2613.
[18] Zainal Abidin H, Oma SC, Mazlan MZ, Hassan MH, Isa R, Ali S, Hassan SK, Ma zuki A. Pos ope a i e maladap i e
beha io , p eope a i e anxie y and eme gence deli ium in child en unde gone gene al anes hesia: a na a i e
e iew. Global Pedia ic Heal h. 2021 Ap ;8:2333794X211007975.
[19] Pe šić Bukmi R, Palje ić E, Pezelj-Riba ić S, B ekalo P šo I. Associa ion o he sel - epo ed socioeconomic and
heal h s a us wi h un ea ed den al ca ies and he o al hygiene le el in adul pa ien s. Den al and Medical
P oblems. 2022 Dec;59(4):539-45.
[20] Gi z SJ, Van de Heijden GJ, Volgenan CM. Unequal smiles: consequences o un ea ed den al ca ies in ci izens
li ing in ulne able ci cums ances in he Ne he lands: an explo a o y pilo s udy. Ac a Odon ologica
Scandina ica. 2024 Oc 3;83:42028.
