Preoperative Anxiety In Pediatric Patients Research Articles

Effects of the Specialized Preoperative Waiting Room on Preoperative Anxiety in Pediatric Patients

Preoperative anxiety is a common event-related psychological disorder, which increases the perioperative risk, especially among children. The aim of this study is to establish a specialized waiting room for pediatric patients and investigate the efficiency on preoperative anxiety. This is a single center, open label, randomized controlled trial. Eligible children were randomly allocated into the routine waiting group (control group) and the specialized waiting group (study group). The Children's Emotional Manifestation Scale (CEMS), crying times, separation emotion, the degree of coordination, satisfaction score of parents, and quality of postoperative recovery were collected and analyzed. A total of 150 children were included and analyzed. Patients in the study group had lower CEMS score, less crying times, better separation emotion and coordination degree, and better recovery quality on the 1<sup>st</sup> postoperative day than those in the control group (<i>p</i><0.05). However, the recovery quality on the 3<sup>rd</sup> or 7<sup>th</sup> postoperative day was comparable between the groups (<i>p</i>>0.05). Besides, the guardians in the study group gave higher scores to the preoperative waiting procedure (<i>p</i><0.05). Our specialized waiting room for pediatric patients is an effective non-pharmacological method to alleviating preoperative anxiety, increasing parents’ satisfaction score, and enhancing recovery quality of the 1<sup>st</sup> postoperative day.

Preoperative anxiety management in pediatric patients: a systemic review and meta-analysis of randomized controlled trials on the efficacy of distraction techniques.

This study addresses the pervasive issue of heightened preoperative anxiety in healthcare, particularly among pediatric patients. Recognizing the various sources of anxiety, we explored both pharmacological and nonpharmacological interventions. Focusing on distraction techniques, including active and passive forms, our meta-analysis aimed to provide comprehensive insights into their impact on preoperative anxiety in pediatric patients. Following the PRISMA and Cochrane guidelines, this meta-analysis and systematic review assessed the efficacy of pharmaceutical and distraction interventions in reducing pain and anxiety in pediatric surgery. This study was registered on PROSPERO (CRD42023449979). This meta-analysis, comprising 45 studies, investigated pharmaceutical interventions and distraction tactics in pediatric surgery. Risk of bias assessment revealed undisclosed risks in performance and detection bias. Distraction interventions significantly reduced preoperative anxiety compared to control groups, with notable heterogeneity. Comparison with Midazolam favored distraction techniques. Subgroup analysis highlighted varied efficacies among distraction methods, with a notable reduction in anxiety levels. Sensitivity analysis indicated stable results. However, publication bias was observed, suggesting a potential reporting bias. Our study confirms distraction techniques as safe and effective for reducing pediatric preoperative anxiety, offering a valuable alternative to pharmacological interventions. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449979, PROSPERO [CRD42023449979].

The Effect of Oral Fluid Administration 1 Hour before Surgery on Preoperative Anxiety and Gastric Volume in Pediatric Patients.

Today, preoperative fasting guidelines have changed, allowing clear liquid intake up to 1 h before surgery. However, concerns remain regarding the risk of aspiration associated with clear liquid intake. This study aimed to investigate the impact of clear fluid given 1 h before surgery on child anxiety and gastric volumes. A prospective, randomized, controlled study included 90 patients aged 5-12 years. The patients were randomly allocated into three groups by a computer-generated randomization: group F (n = 30): standard fasting group, group W (n = 30): patients who received oral water at a dose of 5 mL/kg 1 h before surgery, group C (n = 30): patients who received oral carbohydrate fluid at a dose of 5 mL/kg 1 h before surgery. All patients were assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS) before and 1 h after fluid administration. Antral cross-sectional area (CSA) was measured with ultrasonography after intubation, and gastric residual volume (GRV) was calculated. Hemodynamic data, blood sugar level, and parental satisfaction were also recorded. The m-YPAS scores obtained after 1 h were significantly lower in group C than in the other groups (p < 0.001). Antral CSA and GRV values were lower in group C and group W than in the fasting group (p < 0.001). Parental satisfaction was highest in group C. This study suggests that allowing a carbohydrate-rich clear liquid intake 1 h before surgery can significantly reduce preoperative anxiety in pediatric patients without increasing the risk of aspiration.

Nursing interventions for the management of preoperative anxiety in the pediatric patient

Introduction: Preoperative anxiety in pediatric patients has a high prevalence, negatively affecting the perioperative process of children, increasing the possibility of complications and causing poor pain control. Objectives: Know the existing interventions to reduce preoperative anxiety in pediatric, to study the effectiveness of them and identify the factors that influence it. Methodology: A literature review was performed in three recognized databases between November and December 2022, using as search equation: (intervention) AND (preoperative anxiety) AND (children OR pediatric). The selected studies passed the appropriate methodological quality scale. Results: paciente y el nivel socioeconómico, sobre todo. También estarían implicados factores como el sexo del menor, la separación de los padres que supone la intervención, el aislamiento del entorno social, experiencias previas del menor con el ambiente sanitario/hospitalario y la falta de información acerca del proceso quirúrgico information through comics do not show clear efficacy. The child´s age, level of development and previous experience with the hospital environment influence the effectiveness of these interventions. Conclusion: Interventions that involve a high level of distraction, that provide information and help the child to become familiar with the environment, are the most effective to reduce anxiety in this type of patients, with virtual reality being the most effective in recent studies. In addition, taking into account the characteristics of each patient is crucial to the choice of these interventions and to achieve the greatest effectiveness.

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.

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.
 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.
 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.
 Conclusion: We found an incidence of 42.7% of preoperative anxiety in children undergoing surgery at our hospital.
 Key words; Preoperative Anxiety; Anxiety Score; General Anesthesia; PACU
 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
 Received: August 05, 2023; Reviewed: August 21, 2023; Accepted: August 26, 2023

<p>Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study</p>

BackgroundAnesthesia and surgery are common sources of anxiety and stressful experiences in children. This unpleasant sensation depends on several factors. This study aimed to determine the magnitude of preoperative anxiety and associated factors in pediatrics patients at the University of Gondar Comprehensive Specialized Hospital North West Ethiopia 2020.MethodsAn institutional-based cross-sectional observational study was conducted from March to September 2020 at the University of Gondar Comprehensive Specialized Hospital. After obtaining ethical approval from the institutional review board. All consecutive ASA physical status I & II boys and girls with the age of 2–12 years scheduled for a variety of elective (general, urologic, ENT, ophthalmic and other surgical) operations were included. The level of anxiety was measured using the Modified Yale Preoperative Anxiety Scale short form (m-YPAS-SF) observational tool. Parental anxiety was assessed using Spielberger’s short version of state-trait anxiety. Binary logistic regression analysis was performed to identify the association between preoperative children’s anxiety and independent variables. The strength of the association was present by adjusted odds ratios.ResultsThe magnitude of preoperative anxiety in children in the operation room was 75.44% (95% confidence interval (CI): 68.36, 81.34). Age (AOR: 3.83; 95% CI: 1.58, 9.30), previous surgery and anesthesia (AOR: 6.73, 95% CI: 1.25, 36.19), outpatient surgery (AOR: 5.16, 95% CI: 1.32, 20.23) and parental anxiety (AOR: 3.26, 95% CI: 1.30, 20.23) were significantly associated with preoperative children anxiety.ConclusionThe magnitude of preoperative anxiety in pediatric patients was considerably high in our setup. Younger age, previous surgery and anesthesia, outpatient surgical setting, and parental anxiety were the independent risk factors for preoperative anxiety. Therefore, the operating staff should assess the child’s anxiety and should consider appropriate anxiety reduction methods during the preoperative visit of pediatric patients and their families.

Association of Temperament With Preoperative Anxiety in Pediatric Patients Undergoing Surgery

Preoperative anxiety is associated with poor behavioral adherence during anesthetic induction and adverse postoperative outcomes. Research suggests that temperament can affect preoperative anxiety and influence its short- and long-term effects, but these associations have not been systematically examined. To examine the associations of temperament with preoperative anxiety in young patients undergoing surgery. Studies from MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched from database inception to June 2018. All prospective studies reporting associations of temperament with preoperative anxiety were included. Overall, 43 of 5451 identified studies met selection criteria. Using the PRISMA guidelines, reviewers independently read 43 full-text articles, extracted data on eligible studies, and assessed the quality of each study. Data were pooled using the Lipsey and Wilson random-effects model. Primary outcome was the association of temperament with preoperative anxiety in patients undergoing surgery. A total of 23 studies, with 4527 participants aged 1 to 18 years, were included in this review. Meta-analysis of 12 studies including 1064 participants revealed that emotionality (r = 0.11; 95% CI, 0.04 to 0.19), intensity of reaction (r = 0.29; 95% CI, 0.11 to 0.46), and withdrawal (r = 0.40; 95% CI, 0.23 to 0.55) were positively associated with preoperative anxiety, whereas activity level (r = -0.23; 95% CI, -0.31 to -0.16) was negatively correlated with preoperative anxiety. Impulsivity was not significantly associated with preoperative anxiety. This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies. Future studies should continue to explore temperament and other factors influencing preoperative anxiety and their transactional effects to guide the development of precision treatment approaches and to optimize perioperative care.

The Effect of Gamification through a Virtual Reality on Preoperative Anxiety in Pediatric Patients Undergoing General Anesthesia: A Prospective, Randomized, and Controlled Trial.

The use of gamification in healthcare has been gaining popularity. This prospective, randomized, clinical trial was designed to evaluate whether gamification of the preoperative process—via virtual reality (VR) gaming that provides a vivid, immersive and realistic experience—could reduce preoperative anxiety in children. Seventy children scheduled for elective surgery under general anesthesia were randomly divided into either the control or gamification group. Children in the control group received conventional education regarding the preoperative process, whereas those in the gamification group played a 5 min VR game experiencing the preoperative experience. Preoperative anxiety, induction compliance checklist (ICC), and procedural behavior rating scale (PBRS) were measured. Sixty-nine children were included in the final analysis (control group = 35, gamification = 34). Preoperative anxiety (28.3 [23.3–36.7] vs. 46.7 [31.7–51.7]; p < 0.001) and intraoperative compliance measured using ICC (p = 0.038) were lower in the gamification group than in the control group. However, PBRS (p = 0.092) and parent/guardian satisfaction (p = 0.268) were comparable between the two groups. VR experience of the preoperative process could reduce preoperative anxiety and improve compliance during anesthetic induction in children undergoing elective surgery and general anesthesia.

Effects of micro video combined scene simulation games on preoperative anxiety in pediatric patients with congenital heart disease

Objective To explore the effects of micro video combined scene simulation games on preoperative anxiety in pediatric patients with congenital heart disease. Methods All the participants were divided into two groups, with 100 cases in each. Patients who underwent congenital heart disease surgery from January to June 2016 were allocated in the control group, and from July to December 2016, patients who underwent the same surgery were allocated in the observation group. The patients of the control group were given routine perioperative nursing care. The patients of the observation group were given micro video combined scene simulation games. All the patients were evaluated with the questionnaire of modified Yale Perioperative Anxiety Scale (mYPAS) and Induction Compliance Checklist (ICC) for the degree of preoperative anxiety and the degree of cooperation in the indection period. Results The level of perioperative anxiety of the two groups were (28.58±2.98) and (28.94±2.63) , and there was no statistical difference (P>0.05) . The degree of anxiety in preoperative waiting period of the observation group was (30.21±2.78) , which was lower than that of the control group (36.89±3.41) . The degree of anxiety in the anesthetic induction period was (31.46±3.34) , which was remarkably lower than that of the control group (41.45±4.19) . The degree of cooperation in induction period of the patients in the observation group was (2.67±1.45) , which was lower than that of the control group (6.95±1.78) . All the differences were statistically significant (t=15.21, 18.83, 8.62; P<0.001) . Conclusions Micro video combined scene simulation game can effectively reduce the level of preoperative anxiety in children with congenital heart disease and improve the cooperation in the induction period of anesthesia. Key words: Child, preschool; Anxiety; Congenital heart disease; Micro video; Scene simulation game

Comparing Active and Passive Distraction-Based Music Therapy Interventions on Preoperative Anxiety in Pediatric Patients and Their Caregivers.

Young children who experience high levels of preoperative anxiety often exhibit distress behaviors, experience more surgical complications, and are at a higher risk for developing a variety of negative postoperative consequences. A significant factor in pediatric preoperative anxiety is the level of anxiety present in their caregivers. Active and passive music therapy interventions addressing anxiety prior to invasive procedures have been met with success. The purpose of this study was to investigate the comparative effectiveness of two distraction-based music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers. A total of 40 pediatric patient and caregiver dyads undergoing ambulatory surgery were included in this study. Pediatric preoperative anxiety was measured pre- and post-intervention using the modified Yale Pediatric Anxiety Scale, while caregiver anxiety was measured through self-report using the short-form Strait-Trait Anxiety Inventory-Y6. Participants were randomized to either an active or passive intervention group for a preoperative music therapy session. Results indicated a significant reduction in preoperative anxiety for both patients and their caregivers regardless of intervention type. Neither active nor passive music therapy interventions were significantly more effective than the other. For future studies, the researchers recommend an increased sample size, controlling for various factors such as sedative premedication use, and testing interventions with patients in various stages of development.

Medicación preanestésica con dexmedetomidina intranasal y midazolam oral como ansiolítico. Un ensayo clínico

IntroductionDexmedetomidine is a pharmacological option for sedation in children. In this study, the efficacy of intranasal dexmedetomidine to reduce preoperative anxiety in pediatric patients is compared with that of oral midazolam. Material and methodsA prospective, randomized, double-blind, controlled trial was conducted on children 2-12 years of age, randomly assigned to one of the following two groups: group A received premedication with oral midazolam and intranasal placebo, group B received intranasal dexmedetomidine and oral placebo. Anxiety was assessed with the modified Yale scale, and a risk analysis and number needed to treat was performed. ResultsA total of 108 patients were included, 52 (48.1%) treated with dexmedetomidine, and 56 (51.9%) with midazolam. Anxiety was less frequent in the dexmedetomidine group at 60minutes (P=.001), induction (p=.04), and recovery (P=.0001). Risk analysis showed that dexmedetomidine reduced the risk of anxiety by 28% (RAR=0.28, 95% CI; 0.12 to 0.43) and to prevent one case of anxiety, four patients need to be treated with intranasal dexmedetomidine (NNT=4, 95% CI: 3-9).Changes in heart rate, mean arterial pressure, and oxygen saturation, were statistically significant in the dexmedetomidine group, with no clinical consequences. There were no cases of bradycardia, hypotension or oxygen desaturation. ConclusionsIntranasal dexmedetomidine premedication is more effective than oral midazolam to reduce preoperative anxiety in pediatric patients.

Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients

BackgroundChildren and parents experience significant anxiety and distress during the preoperative period. This is important because preoperative anxiety in children is associated with adverse postoperative outcome. So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application, world-widely used.MethodsA total 120 patients (aged 1-10 years old) who were scheduled for elective surgery under general anesthesia was included in this randomized controlled trial. We randomized the patients into three groups, with using intravenous (IV) midazolam sedation (M group), with using smartphone application program (S group), and with using low dose IV midazolam plus smartphone application program (SM group). And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) at holding area, 5 min after intervention, entrance to operating room.ResultsIn all three groups, mYPAS after intervention were lower than the preoperative holding area (M group 52.8 ± 11.8 vs 41.0 ± 7.0, S group 59.2 ± 17.6 vs 36.4 ± 7.3, SM group 58.3 ± 17.5 vs 26.0 ± 3.4). A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group (P < 0.01), and the SM group exhibited significantly lower anxiety than the two other groups (P < 0.01).ConclusionsThe preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety.