Preoperative Anxiety In Children Research Articles

Preoperative Anxiolytic and Sedative Effects of Intranasal Remimazolam and Dexmedetomidine: A Randomized Controlled Clinical Study in Children Undergoing General Surgeries.

Remimazolam, anultra-short-acting and fast-metabolized sedative, has only been sporadically investigated in children. This study was performed to determine the beneficial effects of intranasal remimazolam or dexmedetomidine on preoperative anxiety in children undergoing general surgeries. Ninety children were randomly and equally assigned to Group R (intranasal remimazolam 1.5mg kg-1), Group D (intranasal dexmedetomidine 2 mcg kg-1), and Group C (intranasal distilled water). The primary outcomes were the preoperative anxiety scores using the modified Yale preoperative anxiety scale (m-Ypas). The secondary outcomes included the cooperation behaviour of intranasal drug application, preoperative sedation levels, parental separation anxiety scores (PSAS), and mask acceptance scores (MAS). Group R showed a significant low anxiety at 10 min after intranasal premedication (vs group C, P=0.010; vs group D, P = 0.002) and at anaesthesia induction (vs group C, P = 0.004). Group D showed a significantly low anxiety score only prior to anaesthesia induction (vs group C, P = 0.005). Most children in group R achieved mild sedation at 10 min (vs group C, P < 0.001; vs group D, P < 0.001), with a few progressing to deep sedation afterwards, while group D tended toward deep sedation. Compared to Group C, patients in Group R performed significantly better on the MAS (P = 0.014) and PSAS (P = 0.008). However, remimazolam did cause poor cooperation behavior to the intranasal application due to its mucosal irritation (vs group C, P = 0.001; vs group D, P = 0.010). Both intranasal remimazolam and dexmedetomidine can effectively alleviate preoperative anxiety in children. While intranasal remimazolam has a rapid onset, it produces only mild sedation and causes substantial nasal irritation. NCT04720963, January 22, 2021, ClinicalTrials.Gov.

The efficacy of finger puppets, distraction cards and kaleidoscope for reducing anxiety in children undergoing day surgery

AimThis study was conducted to determine the efficacy of finger puppets, distraction cards and kaleidoscope for reducing anxiety in children aged 6–12 years who undergoing day surgery in Turkey. MethodsThe study was conducted using the “pre-post test unmatched group model”, one of the quasi-experimental methods. The study was conducted between April 2023 and January 2024 with children aged 6–12 years who were admitted to the pediatric clinic of a hospital for day surgery in the Southern Marmara region of Turkey. A total of 85 children (including 20 children in the control group, 22 children in the finger puppet intervention group, 21 children in the distraction cards intervention group, and 22 children in the kaleidoscope intervention group) who were hospitalized in the pediatric clinic. ResultsIt was determined that there was a statistically significant difference between the pre- and post-intervention the Modified Yale Preoperative Anxiety Scale Child Form (m-YPAS) sub-dimension and total mean scores of the children in the kaleidoscope, finger puppet and distraction cards groups, while there was no difference in the control group children. ConclusionKaleidoscope, finger puppet and distraction cards interventions were found to be effective in reducing preoperative anxiety in children and contributed to the national and world literature. It is recommended that further studies be conducted on the effectiveness of the three methods and that other variables that may affect the child's anxiety be addressed. Contribution to nursing practiceThis finding can be interpreted as significant and positive in demonstrating that anxiety induced by surgical procedures in children can be effectively managed with non-pharmacological methods.

A bibliometric analysis of research on pediatric preoperative anxiety (2007-2022).

This study aimed to analyze the current state of research on preoperative anxiety in children through CiteSpace, VOSviewer, and the identification of hot spots and frontiers. Relevant data were retrieved from the Web of Science Core Collection using the search terms children and preoperative anxiety. Data were analyzed using VOSviewer (version 1.6.18), CiteSpace (5.7. R5) software, and Scimago Graphica. A total of 622 articles were published between 2007 and 2022, with an increasing trend over time. Kain, Zeev N. (13; 2.09%) and Dalhousie University (15; 2.41%) were the most influential authors and most prolific institutions, respectively. The United States (121; 19.45%) was the country with the most publications. Pediatric anesthesia (55; 8.84%) had the most publications. High-frequency keywords were categorized into three themes, including nonpharmacologic interventions for preoperative anxiety in children, preoperative medications, and risk factors for anxiety; of these, "predictor" (38; 2016) and "sedative premedication" (20; 2016) were the most studied keywords over the past 6 years. "Distraction" (67; 2019) and "dexmedetomidine" (65; 2019) have been the main areas of interest in recent years. Research on preoperative anxiety in children has been the focus of increasing attention over the past fifteen years, with the majority of publications from high-income countries. This review provides a useful perspective for understanding research trends, hot topics, and research gaps in this expanding field.

Anxiolytic and Sedative Properties of Melatonin Premedication in Pediatrics Undergoing Elective Cardiac Catheterization: A Randomized Placebo Study.

Preoperative anxiety in children has been linked to various postoperative consequences, such as postoperative regressive behavioral issues, extended distress during the recovery period, eating disorders, and bedwetting. The current study aimed to investigate the efficacy of low-dose oral melatonin in alleviating preoperative anxiety among children in the Iraqi population. A randomized, double-blinded comparative study was undertaken, involving children aged four to 14 years scheduled for elective cardiac catheterization under general anesthesia. The study comprised a total of 80 children. The involved individuals were randomly assigned to two groups, each with 40 subjects. Group A received 0.5 mg/kg melatonin as premedication, while Group B received a placebo. The two groups demonstrated similarity in mean age, weight, cardiac disease, and gender distribution. Statistically significant reductions in anxiety scores were observed in the melatonin group compared to the placebo group. Particularly, children administered 0.5 mg/kg melatonin exhibited the most substantial anxiolysis and venipuncture compliance (P < 0.05). Additionally, children who were premedicated with melatonin experienced decreased cognition, maximum sedation, successful parental separation, and psychomotor impairment (P < 0.05). Melatonin demonstrated an effective sedation level without significant side effects, making it a preferred choice due to its efficacy, safety, current availability, and cost-effectiveness compared to other anesthetic agentsused in premedication procedures.

Effective doses of midazolam oral solution for the prevention of preoperative anxiety in paediatric patients.

More than 60% children exhibit anxiety before undergoing an anesthetic-surgical procedure, particularly among pre-school paediatric patients. Oral midazolam can provide procedural sedation for children prior to anesthesia. However, extemporaneous solutions of midazolam are usually prepared from injectable drug solutions, leading to inconsistent efficacy due to variable preparation methods. Xiaoerjing® is the first commercially available oral formulation of midazolam for procedural sedation in children in China. Despite the recommended dosage range of 0.25-0.5 mg/kg, its effective dose is still largely unknown. To determine the 95% effective dose (ED95) of midazolam oral solution (Xiaoerjing®) for alleviating preoperative anxiety in children prior to mask induction of general anesthesia. The study included 61 children between the ages of 1 and 6 years undergoing elective surgery under general anesthesia. The first patient received a single dose of 0.5 mg/kg midazolam oral solution, which was adjusted for subsequent patients using the biased coin design method based on their response to the previous dose. Doses were increased or decreased at the rate of 0.1 mg/kg. An effective response was defined as having a modified Ramsay sedation score ≥3a, separation anxiety score ≤2, and mask acceptance score ≤2 during inhalational anesthesia induction. Fifty-six children were included in the final analysis. Of those, sedation was successful in 50 patients, with a median separation time of 15 (IQR: 25) min. Midazolam oral solution has an ED95 of 0.8254 mg/kg (95% CI: 0.6915-0.8700 mg/kg) for relieving preoperative anxiety in children. No adverse events occurred following drug administration. Midazolam oral solution is a safe and effective medication for relieving preoperative anxiety in children. The ED95 of a single oral dose of midazolam oral solution is 0.8254 mg/kg (95% CI: 0.6915-0.8700 mg/kg).

Effects of music therapy on degree of cooperation with anesthesia induction and preoperative anxiety in children with simple congenital heart disease: A protocol of systematic review and meta-analysis.

Anxiety is a common preoperative symptom in children with simple congenital heart disease (SCHD). Music therapy shows potential as a non-drug intervention. However, it is unclear how it impacts the level of cooperation during the induction of anesthesia and preoperative anxiety, as well as the factors that influence its effectiveness. Therefore, we will conduct a comprehensive review and meta-analysis to assess the impact of music therapy on the level of cooperation during anesthesia induction and preoperative anxiety in children with SCHD. Electronic searches will be conducted through various databases including PubMed, Embase, Web of Science, Medline, and CNKI to gather randomized controlled trials (RCTs) examining the impact of music therapy on the level of cooperation during anesthesia induction and preoperative anxiety among children with SCHD. Two evaluators will independently review the literature, extract information, and assess the risk of bias in the included studies. Afterwards, data analysis will be conducted using Stata 14.0 software and Revman 5.4 software. The results will be based on random-effects models. The reliability and quality of evidence will be evaluated by using the Grading of Recommendations, Development, and Evaluation (GRADE) system. Heterogeneity will be examined by subgroup analysis stratified by age, gender ratio, type of surgery, drop-out rate, measurement tools, and country of origin. We will assess potential publication bias using funnel plot symmetrical and Begg's ang Egger's regression tests. Given the multiple advantages that may be associated with music therapy, this therapy may be a desirable alternative to existing therapies for preoperative cooperation and anxiety issues in children with SCHD. We hope that this systematic review will guide clinical decision-making for future efforts related to coping with preoperative fit and anxiety in children with SCHD. PROSPERO registration number: CRD42023445313. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023445313.

Effect of video distraction on preoperative anxiety scores in pediatric patients undergoing general anesthesia in ophthalmic daycare procedures: A randomized controlled trial.

Parental separation, fear, and exposure to the operating room environment lead to stress and anxiety in pediatric patients. This study aims to identify the research gaps in the effect of video distraction on pediatric patients of Indian origin. We hypothesized that video distraction along with parental presence would reduce preoperative anxiety in pediatric patients undergoing ophthalmic procedures under general anesthesia compared with parental presence alone. In this prospective randomized trial, 145 patients aged 2-8 years, ASA I-II, with at least one functional eye undergoing elective ophthalmic daycare procedures were enrolled. They were randomly allocated to two Groups: Group V had distraction by watching a video/playing a video game together with parental presence, whereas control Group C had parental presence alone without any video distraction. The primary objective of the study was to compare preoperative anxiety using the Modified Yale Preoperative Anxiety score (mYPAS) and heart rate (HR), whereas the secondary objective was to compare child fear, emergence delirium, and parental satisfaction between the two groups. The three time points for intergroup comparisons were the preoperative holding area 10 min before induction (T0), transport of the child to the operating room (T1), and face mask introduction (T2). There was a statistically significant difference between mYPAS score in groups V and C at all time points (P = 0.036, P = 0.0001, P = 0.0000), parental satisfaction score at all three time points (P = 0.0049, P = 0.0000, P = 0.0000), and Child Fear Score at T1 and T2 (P = 0.0001, P = 0.0001, respectively). However, there was no statistically significant difference in the emergence of delirium between the two groups. Video distraction together with parental presence has a promising role for implementation in hospitals with heavy workload settings where pharmacological intervention would not be feasible, to alleviate preoperative anxiety in children. However, preoperative anxiety may not translate into increased postoperative emergence delirium as was earlier believed.

Effects Of Health Promotion Through Animation Video In Reducing Anxiety Among Hypertension Patients: A Literature Review

Introduction: Anxiety is a state of unease or apprehension that arises from the expectation of potential harm, frequently without a clear or identifiable cause. An individual undergoing anxiety might induce a rise in blood pressure. Anxiety exacerbates hypertension by causing vasoconstriction, resulting in elevated blood pressure. Regarding the correlation between anxiety and hypertension, it is crucial to address anxiety in individuals with hypertension. There are multiple methods available to address this anxiety, including both pharmaceutical and non-pharmacological approaches. Material and Methods: This study is a review of existing literature. The researchers aimed to locate scholarly literature about the use of animated movies as a means of alleviating anxiety in individuals diagnosed with hypertension. Articles about the specified theme were chosen from 2018 to 2023 using electronic databases such as Science Direct, PubMed, and Google Scholar and open knowledge maps during the article search. The researchers employed the PRISMA methodology to analyze the literature review studies. Results: 174 articles were chosen using the keywords Health Promotion, Animation Video, Anxiety, and Hypertension. The research underwent a comprehensive review encompassing its aims, samples, methods, and results. Based on the literature review findings, there needs to be more participants or samples that align with the focus of this study. Researchers did not discover any instances of anxiousness in individuals with hypertension through the examination of samples. However, researchers conducted studies on various topics, including the impact of using animated videos to promote health in reducing anxiety among postpartum patients, preoperative anxiety in children, and hypertension. These findings are presented in Table 1. Nevertheless, scholars might engage in discussions regarding the impacts of animated videos. The researchers selected and evaluated only ten publications despite their lack of relevance to the research area of this literature review. Conclusion: Out of the 10 articles examined, many employed animated videos as interventions. However, researchers did not discover any studies specifically focused on investigating the impact of using animated videos for health promotion in reducing anxiety among hypertensive patients. The researchers discovered an independent subject. Consequently, researching this topic can contribute innovatively to future investigations.

The MAGIC trial: a pragmatic, multicentre, parallel, noninferiority, randomised trial of melatonin versus midazolam in the premedication of anxious children attending for elective surgery under general anaesthesia

BackgroundChild anxiety before general anaesthesia and surgery is common. Midazolam is a commonly used premedication to address this. Melatonin is an alternative anxiolytic, however trials evaluating its efficacy in children have delivered conflicting results. MethodsThis multicentre, double-blind randomised trial was performed in 20 UK NHS Trusts. A sample size of 624 was required to declare noninferiority of melatonin. Anxious children, awaiting day case elective surgery under general anaesthesia, were randomly assigned 1:1 to midazolam or melatonin premedication (0.5 mg kg−1, maximum 20 mg) 30 min before transfer to the operating room. The primary outcome was the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes included safety. Results are presented as n (%) and adjusted mean differences with 95% confidence intervals. ResultsThe trial was stopped prematurely (n=110; 55 per group) because of recruitment futility. Participants had a median age of 7 (6–10) yr, and 57 (52%) were female. Intention-to-treat and per-protocol modified Yale Preoperative Anxiety Scale-Short Form analyses showed adjusted mean differences of 13.1 (3.7–22.4) and 12.9 (3.1–22.6), respectively, in favour of midazolam. The upper 95% confidence interval limits exceeded the predefined margin of 4.3 in both cases, whereas the lower 95% confidence interval excluded zero, indicating that melatonin was inferior to midazolam, with a difference considered to be clinically relevant. No serious adverse events were seen in either arm. ConclusionMelatonin was less effective than midazolam at reducing preoperative anxiety in children, although the early termination of the trial increases the likelihood of bias. Clinical trial registrationISRCTN registry: ISRCTN18296119.

Validity of the modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale for children in a preoperative setting.

The perioperative period can be stressful for children and families. Minimizing child distress and investigating the quality of anesthetic care is important. There is a paucity of assessment tools available to assess perioperative anxiety in children. To determine the validity and reliability of the modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale in a perioperative setting for children. Children (n = 189, 3-12 years old) scheduled for ear, nose, and throat surgery had their anxiety rated at induction by a registered nurse anesthetist. Two observers individually evaluated video recordings of the perioperative period. The Verbal-Numeric-Anxiety-Fear-Rating-Scale was used to assess the children's preoperative anxiety and fear, and the modified-Distraction-Short-Scale was used to evaluate coping behavior. The modified-Yale-Preoperative-Anxiety-Scale was used to measure preoperative anxiety and behavioral compliance during anesthesia induction. Interrater reliability showed excellent agreement between observers on modified-Distraction-Short-Scale scores (weighted kappa (Kw ) = 0.91) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (Kw = 0.84). The agreements between the registered nurse anesthetist and observers were moderately good for modified-Distraction-Short-Scale (Kw = 0.65-0.80) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (Kw = 0.65-0.75). The intraclass correlation coefficient (ICC) for the registered nurse anesthetist and two observers was excellent for modified-Distraction-Short-Scale scores (ICC = 0.96) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (ICC = 0.90). Regarding concurrent validity, modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores were strongly correlated among all three observers (Spearman's correlation coefficient [rs ] = 0.75-0.82). The modified-Yale-Preoperative-Anxiety-Scale scores were moderately correlated with modified-Distraction-Short-Scale (rs = 0.57-0.66) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (rs = 0.54-0.67). Construct validity was tested by using age as a discriminating variable, and Verbal-Numeric-Anxiety-Fear-Rating-Scale, modified-Distraction-Short-Scale, and modified-Yale-Preoperative-Anxiety-Scale scores were lower for the older age group; however, only modified-Distraction-Short-Scale (Observer 1: p = .035, Observer 2: p = .022), and modified-Yale-Preoperative-Anxiety-Scale scores were significantly lower (p < .001). The modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale are simple and valid tools for assessing children's perioperative anxiety or fear and evaluating coping behavior. These results suggest that both scales are useful tools for routine clinical practice and research.

ED95 of remimazolam in nasal administration for attenuating preoperative anxiety in children.

Preoperative anxiety often prevails in children at higher levels than adults, which is a common impediment for surgeons and anesthesiologists. It is of great necessity to explore an appropriate medication to improve this situation. Remimazolam, a type of benzodiazepine drug, has been indicated for the induction and maintenance of procedural sedation in adults since 2020. To date, rare studies were reported to investigate the effect of remimazolam on children. In this study, we investigated the safety and efficacy of intranasal drops of remimazolam and tried to determine the 95% effective dose (ED95) of remimazolam in single intranasal administration in attenuating preoperative anxiety in children. In this study, 114 children were enrolled who underwent laparoscopic high-level inguinal hernia ligation between January 2021 and December 2022 and were divided into an early childhood children group and a pre-school children group. The biased coin design (BCD) was used to determine the target doses. A positive response was defined as the effective relief of preoperative anxiety (modified Yale Preoperative Anxiety Scale, mYPAS < 30). The initial nasal dose of remimazolam was 0.5 mg·kg-1 in the two groups. An increment or decrement of 0.1 mg·kg-1 was applied depending on the sedative responses. Isotonic regression and bootstrapping methods were used to calculate the ED95 and 95% confidence intervals (CIs), respectively. A total of 80 children completed the study, including 40 in the early childhood group and 40 in the pre-school children group. As statistical analysis indicated, the ED95 of a single intranasal infusion of remimazolam for the relief of preoperative anxiety is 1.57 mg·kg-1 (95% CI: 1.45-1.59 mg·kg-1) in early childhood children and 1.09 mg·kg-1 (95% CI: 0.99-1.11 mg·kg-1) in pre-school children, and the CIs did not overlap each other. Remimazolam is an effective medication to relieve preoperative anxiety in children. Moreover, the ED95 of single nasal administration of remimazolam for effective relief of preoperative anxiety was 1.57 and 1.09 mg·kg-1 in early childhood children and pre-school children, respectively.

Comment: Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials.

Comment: Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials.

Incidence and risk factors associated with negative postoperative behavioral changes in children undergoing painless gastroscopy

ObjectiveTo investigate the incidence of and risk factors associated with negative postoperative behavioral changes (NPOBCs) in children undergoing painless gastroscopy.MethodsInclusion criteria: ASA I–II and outpatients aged 6–12 years undergoing painless gastroscopy. Exclusion criteria: history of surgery or anesthesia, children with developmental or intellectual abnormalities, refusal to participate, preoperative abdominal pain score > 3 points, history of chronic abdominal pain of > 3 months duration, and serious intraoperative complications. On the 1st, 14th, and 30th day after the gastroscopy, the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) was used to assess NPOBCs in children.ResultsA total of 1,670 children were included in this prospective observational cohort study. The incidence rates of NPOBCs were 14.13%, 4.55%, and 2.14% on the 1st, 14th, and 30th day after gastroscopy, respectively. The risk factors for the first day were female sex (OR 1.34, 95% CI 1.00–1.79), parental anxiety (OR 2.23, 95% CI 1.75–3.12), and severe anxiety in children (OR 2.83, 95% CI 1.96–4.07). The risk factors on the 14th day were parental anxiety (OR 3.71, 95% CI 2.19–6.29), a parental educational level above high school (OR 1.65, 95% CI 1.00–2.70), and severe anxiety in children (OR 11.87, 95% CI 5.85–24.07). The risk factors on the 30th day were female sex (OR 2.99, 95% CI 1.41–6.34), being an only child (OR 4.42, 95% CI 2.18–8.95), a parental educational level above high school (OR 2.66, 95% CI 1.27 NPOBCs 5.56), and severe anxiety in children (OR 6.84, 95% CI 2.84–16.49).ConclusionIn children undergoing painless gastroscopy, the incidence rates of NPOBCs on the 1st, 14th, and 30th day were 14.13%, 4.55%, and 2.14%, respectively. The risk factors for NPOBCs were severe anxiety in children, female sex, parental anxiety, and a parental educational level above high school. In particular, severe preoperative anxiety in children was a persistent risk factor for NPOBCs within 30 days.

Incidence of preoperative anxiety and associated features in children undergoing general anesthesia for a surgery in Middle East population

Background: Children usually experience anxiety before undergoing general anesthesia. We did this prospective cross-sectional study to find the incidence of preoperative anxiety in children undergoing surgery in a tertiary care hospital.&#x0D; Methodology: This study was conducted at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. We included children aged 2-12 y, who were planned to undergo general anesthesia for surgery. Preoperatively, children’s anxiety level was assessed using mYPAS (Modified Yale Preoperative Anxiety Scale) scale. We report the incidence of preoperative anxiety as numbers and percentages. We also report the features of children with preoperative anxiety.&#x0D; Results: A total of 96 children were included in the study. The median anxiety score of children was 26.60 (23.3-41.66). The incidence of preoperative anxiety in pediatric patients was 42.7% (41 cases). The median age of children having preoperative anxiety was lower 55 (44-69.5) months vs 67 (35-90) months in children without anxiety. Sixty-three percent of children with preoperative anxiety underwent ENT and dental surgeries.&#x0D; Conclusion: We found an incidence of 42.7% of preoperative anxiety in children undergoing surgery at our hospital.&#x0D; Key words; Preoperative Anxiety; Anxiety Score; General Anesthesia; PACU&#x0D; Citation: Huda AU, Arif A, Asim Z. Incidence of preoperative anxiety and associated features in children undergoing general anesthesia for a surgery in Middle East population. Anaesth. pain intensive care 2023;27(5):575−578; DOI: 10.35975/apic.v27i5.2314&#x0D; Received: August 05, 2023; Reviewed: August 21, 2023; Accepted: August 26, 2023

A COMPARISON OF EFFICACY OF INTRANASAL FENTANYL AND INTRANASAL DEXMEDETOMIDINE AS PREMEDICATION IN PEDIATRIC PATIENTS

Objective: The objective of the study was to determine the effects of intranasal fentanyl compared to intranasal dexmedetomidine, when used for relieving pre-operative anxiety in children on the basis of onset and quality of anxiolysis, parental separation, hemodynamic stability, and cooperation to mask holding. Methods: A prospective observational study was conducted in Government Medical college Kottayam for a period of 12 months from December 2021 to December 2022, randomly assigned a total of 40 pediatric patients (the American Society of Anesthesiologists I and II) in the age group 3–6 years, undergoing elective surgeries requiring general anesthesia who received either intranasal fentanyl (group F) or intranasal dexmedetomidine (group D). Onset and quality of anxiolysis was compared using modified Yale pre-operative anxiety scale. Parental separation score, hemodynamic stability, and cooperation to mask holding were compared. Data collected were analyzed using SPSS version 25. Results: Children who received intranasal fentanyl as premedication had better quality and onset of anxiolysis as compared to dexmedetomidine group. In parent-child separation, intranasal fentanyl was found to be better than intranasal dexmedetomidine. Conclusion: We conclude that intranasal fentanyl is superior to intranasal dexmedetomidine in relieving pre-operative anxiety in pediatric population of age 3–6 years.

The benefits of experiencing flow through distracting activities: flow reduces preoperative anxiety in children before surgery, but not postoperative difficulties

Background Distraction is a classic anxiety management strategy in preoperative setting with children: distracting activities take children’s attention away from threatening clues. What is less clear is the differential effectiveness of this technique depending on the task, and the degree of children engagement with the distracting task. The present work examined the role of flow (state of intense concentration and absorption in the distracting task) on children’s preoperative anxiety. Methods Anxiety and flow in a distracting activity were measured in a sample of 100 children (3 to 10 years-old), at two critical moments of the preoperative period prior to ambulatory surgery under general anesthesia (phase 1: up to separation from the parents; phase 2: up to general anesthesia). Common negative postoperative outcomes were also measured. Results As expected, the analysis showed a negative association between the mean level of flow in the distracting activity during waiting periods and the preoperative anxiety of children at critical moments in the two phases (although there was no effect on postoperative recovery). Conclusion These findings demonstrate the importance of considering the degree of engagement in the distracting activity to understand the effectiveness of this strategy. The results may help provide guidance for better clinical application of this method.

PERIOPERATIVE ANXIETY IN CHILDREN: NARRATIVE REVIEW

Preoperative anxiety in children is common and can have negative effects on their overall surgical experience. Several factors, such as age, personality traits, and past medical experiences, can contribute to increased preoperative anxiety. Behavioral interventions, such as distraction techniques, parental presence at induction of anesthesia, and preoperative preparation programs, can be effective in reducing anxiety. Behavioral family preparation programs have been found to reduce the number of children requiring preoperative sedation, but they may not be practical for all centers. Anesthesiologists and child life specialists can play an essential role in reducing anxiety in children by interacting with them in an age-appropriate way, providing therapeutic play experiences, and offering developmentally appropriate language. Distraction techniques, such as non-procedural distracting talk, electronic devices, music, stories, and guided imagery, can also help children cope with anxiety. Pharmacological interventions, such as sedative premedication, should be used with caution, especially for children with neurodevelopmental disorders, due to potential drug interactions and increased risks of upper airway obstruction.

Effect of interactive, multimedia-based home-initiated education on preoperative anxiety inchildren and their parents: a single-center randomized controlled trial

BackgroundAnesthesiologists need to appreciate the impact of preoperative anxiety in children. The present study aimed to explore whether interactive multimedia-based home-initiated interventions could effectively relieve preoperative anxiety in pediatric patients.MethodsIn this prospective study, we compared preoperative anxiety between two groups of children aged 4–9 years. Children in the control group received a question-and-answer (Q&A) introduction, and children in the intervention group received multimedia-based home-initiated preoperative education using comic booklets, videos, and coloring game books. Differences in anxiety between the two groups were evaluated by the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) at four time points: in the ophthalmology outpatient clinic before intervention as the baseline (T0); in the preoperative waiting area (T1); at the time of separating from their parents and moving to the operating room (T2); and at the time of anesthesia induction (T3). Parental anxiety was assessed by the Self-rating Anxiety Scale (SAS) and Visual Analog Scale (VAS) at T0 and T2. Other related information was collected by questionnaire.ResultsEighty-four children who underwent pediatric strabismus in our center between November 2020 and July 2021 were included in this study. An intention-to-treat (ITT) analysis was performed on data from 78 enrolled children. Children in the intervention group exhibited lower m-YPAS-SF scores at T1, T2, and T3 than those in the control group (all p < 0.001). By using a mixed-effect model with repeated measurement (MMRM) after adjusting the m-YPAS score at T0 as a covariate, the interventional effect in terms of themYPAS-SF score was also significant over time (p < 0.001). The percentage of children with perfect induction compliance (ICC = 0) in the intervention group was significantly higher than that in the control group [18.4% vs. 7.5%], and poor induction compliance (ICC>4) was lower (2.6% vs. 17.5%, p = 0.048). The mean parental VAS score at T2 in the intervention group was significantly lower than that in the control group (p = 0.021).ConclusionsInteractive multimedia-based home-initiated intervention could reduce preoperative anxiety in children and improve the quality of anesthesia induction based on ICC scores, which may in turn impose a positive impact on parental anxiety.

Preoperative Anxiety and Postoperative Pain in Children with Burn Patients and Their Correlation Analysis

Background: Burn is a kind of skin tissue damage under the influence of heat source, which is a common type of accidental injury in current society. Objective: To investigate the status of preoperative anxiety and postoperative pain in children with burn patients, and to analyze the correlation between preoperative anxiety and postoperative pain. Methods: A total of 108 pediatric patients who underwent burn surgery under general anesthesia in our hospital from October 2020 to August 2021 were selected. FLACC and Facial Expression Pain Scale were used to evaluate the pain of the children, and STAI and YPAS were used to evaluate the anxiety of the children. Correlation was used to analyze the effect of preoperative anxiety on postoperative pain in burn children. Results: Preoperative anxiety and severe anxiety accounted for more than 50% of burn children, and there was a statistically significant difference in preoperative anxiety and postoperative pain between 1-3-year-old children and 4-12-year-old children. The influencing factors of postoperative pain in children with burns were analyzed, including burn area, depth of burn, and previous operations. The multivariate analysis showed that the risk factors for postoperative pain in children were age, burn area, depth of burn, preoperative anxiety of children, and parental trait anxiety, after statistical test, it shows that each influencing factor has a significant influence on postoperative pain in children (P &lt; 0.05). In the correlation analysis of preoperative anxiety and postoperative pain in children with burns, it was shown that preoperative anxiety in children aged 1 to 3 years had a significant impact on postoperative pain of children, and the correlation analysis showed that preoperative anxiety of children with burns There was a positive correlation between anxiety score and postoperative pain (r=0.479, P=0.001). Conclusion: The incidence of preoperative anxiety in children with burn patients is high, and the postoperative pain scores are also different in different age groups. In addition, there is a current correlation between preoperative anxiety and postoperative pain in children with burn patients, and the correlation is positively correlated, that is, the higher the patient's anxiety score, the more intense the patient's postoperative pain.

Is Preoperative Anxiety Affected by Watching Short Videos on Social Media? A Prospective Randomized Study

PurposeThe purpose of this study was to investigate the impact of watching short videos in the preoperative waiting room on preoperative anxiety in children. DesignThis study was designed as a prospective, randomized trial including 69 ASA I-II patients aged 5 to 12 years who were scheduled for elective surgery. MethodsThe children were randomly allocated to two groups. The experimental group browsed short videos on a social media platform (eg, YouTube short, TikTok, Instagram reels) for 20 minutes in the preoperative waiting room, but the control group did not. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) at different time points: on arrival in the preoperative waiting room (T1), right before being taken to the operating room (OR) (T2), on entering the OR (T3), and during anesthesia induction (T4). The primary outcome of the study was children's anxiety scores at T2. FindingsThe mYPAS scores at T1 were similar in both groups (P = .571). The mYPAS scores at T2, T3, and T4 were significantly lower in the video group than in the control group (P < .001). ConclusionsWatching short videos on social media platforms in the preoperative waiting room lowered preoperative anxiety levels in pediatric patients aged 5 to 12.