Preoperative Behavioral Stress Response in Children: Is There a Role (What Is the Role) for Oral Pre-Medication in Out Patient Surgery?

Abstract

Preoperative anxiety and behavioral stress response in children is a common and vexing problem in the surgical arena as well as other heath care environments. Risk factors associated with this response include: Young age, especially pre-school, previous surgery, especially one associated with a “poor quality encounter,” lack of pre-operative visit/orientation, shy and inhibited temperament, anxious parents, and parental prediction of uncooperative behavior. The stress response has been shown repeatedly to be undesirable on the day of surgery for the child, family and hospital personnel but also to have long-term psychologically traumatic consequences. A general and reasonable assumption has been made that any procedure that will reduce the child’s fear of the anesthesia/surgical experience will tend to reduce its traumatic effect. Approaches to reduce anxiety fall into two categories: psychological and pharmacological. Psychological factors tend to focus on pre-operative preparation/orientation programs for child and family, parental presence during the induction of anesthesia, and induction sequence techniques, including a variety of distraction methods. Pharmacological factors include using a sedative or anxiolytic agent. All of the above psychological approaches effectively reduce anxiety and therefore improve the surgical/anesthetic experience for all involved. Preoperative preparation programs tend to enhance coping skills and provide a sense of control and mastery over the procedures.