Separation Anxiety Scale Research Articles

Intranasal esketamine versus esketamine-dexmedetomidine combination for premedication in pediatric patients undergoing strabismus surgery: a randomized controlled trial.

Preoperative fear and anxiety are prevalent in children undergoing surgery. The combination of esketamine and dexmedetomidine has been proposed as a promising premedication for enhancing preoperative sedation and analgesia. This study compared the premedication efficacy of intranasal esketamine alone and esketamine-dexmedetomidine combination in pediatric patients undergoing strabismus surgery. One hundred and eighty preschool children aged 2-6 years scheduled for strabismus surgery were enrolled and randomly assigned to one of the three groups: intranasal premedication with esketamine 2 mg/kg (Group K), esketamine 1 mg/kg and dexmedetomidine 1 µg/kg (Group KD1), or esketamine 0.5 mg/kg and dexmedetomidine 2 µg/kg (Group KD2). The primary outcome was the level of sedation following the intervention, as measured by the modified Yale preoperative anxiety scale (mYPAS) and sedation scale (SS). Secondary outcomes included onset time of sedation, the successful rate of peripheral intravenous cannulation, parental separation anxiety scale (PSAS), mask acceptance scale (MAS), wake-up time, duration of stay in the post-anesthesia care unit (PACU), and premedication-related adverse effects. After premedication, the mYPAS score gradually decreased in the three groups, with lower values in Group K than in Group KD1 and Group KD2 patients in 1, 5, and 10 min. SS in Group KD1 and Group KD2 steadily increased until 40 min after premedication, while SS in Group K increased in the first 5 min after premedication and maintained consistent levels during the remaining time. Sedation onset was substantially faster in Group K patients (11.4±7.8 min) than Group KD1 (18.1±7.5 min, P=0.006) and Group KD2 (18.4±6.8 min, P<0.001). PSAS, separation status, the successful rate of peripheral intravenous cannulation, and MAS were comparable among groups. There was no significant difference in terms of emergence time or duration of stay in the PACU among groups. More gastrointestinal events were observed in Group K (P<0.001). Intranasal premedication with 2 mg/kg esketamine produced a more rapid onset of sedation accompanied by more gastrointestinal reactions compared with a combination of esketamine and dexmedetomidine. ClinicalTrials.gov identifier: NCT04757675.

Immersive Virtual Reality Versus Video Distraction for the Management of Emergence Delirium in Children: A Randomized Controlled Study

PurposeEmergence delirium (ED) presents challenges for both parents and health care providers in pediatric surgical settings. This study aims to evaluate the effectiveness of immersive virtual reality (VR) distraction and video distraction combined with parental presence in reducing ED in preschool-aged children undergoing elective surgery. DesignA prospective, randomized, controlled clinical trial was conducted with 90 children ages 4 to 7. Participants were randomly assigned to three groups: VR distraction (group V), tablet video distraction with parental presence (group T), and standard care (group C). The primary endpoints were the incidence of ED and Pediatric Anesthesia Emergence Delirium Scale scores, with secondary measures encompassing scores from the Parental Separation Anxiety Scale and the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. MethodsParticipants were assigned to one of the three intervention groups, and relevant scales were used to assess ED, parental separation anxiety, and postoperative pain. The immersive VR distraction and video distraction with parental presence interventions were compared against standard care. FindingsImmersive VR distraction significantly reduced the incidence of ED (6.67% in group V vs 40% in group T and 60% in group C), and the incidence of ED in group V was notably lower than in the other groups (P = .023 vs group T and P = .004 vs group C). Children in group V displayed significantly lower FLACC compared with the other groups as well (P < .05). However, no significant differences between the 3 groups were observed in perioperative anxiety as assessed by the Parental Separation Anxiety Scale scores (P = .27). ConclusionsThis study underscores the potential of immersive VR distraction as an effective intervention for mitigating ED in pediatric surgical patients. The findings suggest that incorporating VR technology during the perioperative period can positively impact postoperative outcomes. Further research in diverse surgical contexts is recommended to validate these findings and explore the broader applicability of VR distraction in pediatric health care settings.

Association of problems, coping styles, and preferred online activity with depression, anxiety, and other psychological disorders in Turkish adolescents diagnosed with chronic kidney disease

BackgroundTo assess depression, anxiety, and other psychological disorders in adolescents with chronic kidney disease (CKD) and determine the significant factors and the effect of digital media use on its scores among these patient groups.MethodsThe study was conducted as a cross-sectional study and included 84 adolescents with CKD and 68 healthy controls. The participants completed the Revised Child Anxiety and Depression Scale (RCADS). We recorded their age, gender, the most problematic issue in their lives, coping methods with problems, and online applications they prefer in their leisure time.ResultsElevated rates (scores > 70) of separation anxiety, panic disorder, obsession, depression, total anxiety, and total depression scales were statistically higher in the CKD group. Separation anxiety, panic disorder, obsession, total anxiety, and total depression scales were higher in girls, and panic disorder, obsession, depression, total anxiety, and total depression scores were higher in younger ages in multivariate analysis. In the CKD group, family issues/problems increased panic disorder, obsession, depression, total anxiety, and total depression scales. Crying in tears/yelling response in children while facing a problem was associated with increased separation anxiety and social phobia rates. Also, preferring video applications was associated with separation anxiety and messaging applications with depression, total anxiety, and total depression.ConclusionsAdolescents with CKD are at risk for depression, anxiety, obsession, and panic disorders. Also, crying in tears/yelling response may be at greater risk for anxiety among CKD adolescents. Early psychiatric evaluation and routine psychiatric follow-ups initiated early may improve the mental health of this vulnerable population.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

Longitudinal Measurement Invariance of the DSM-5 Anxiety and Depression Severity Measures

Abstract: There is scarce evidence on the psychometric properties of the Severity Measures (SMs) of the DSM-5 longitudinally, especially among Spanish young adults. Thus, the main objective of the present study was to analyze the Longitudinal Measurement Invariance (LMI) of the SMs for Depression, Generalized Anxiety, Social Anxiety, Panic, Separation Anxiety, Agoraphobia, and Specific Phobia scales in four assessment waves at 6-month intervals. A total of 564 Spanish young adults ( Mage = 21.5 years; 67.9% females) participated in the study. Confirmatory Factor Analyses (CFAs) were carried out at each wave. Once the adequacy of the factor structure of the models was confirmed, three levels of LMI were examined (i.e., configural, metric, and scalar). Finally, we examined internal consistency (i.e., Cronbach’s α and ω) across assessment waves and gender groups. CFAs analyses supported a two-factor solution for the specific phobia scale and a one-factor solution for the rest of the SMs in baseline models. Evidence of LMI at the configural, metric, and scalar levels was observed for all seven SMs. Reliability indices ranged from .73 to .96. These results suggest that the DSM-5 SMs are useful assessment tools for longitudinal and follow-up studies in Spanish young adults.

Depression, anxiety, eating problems, and diabulimia risk in adolescents with type 1 diabetes: a case-control study.

Type 1 diabetes (T1D) causes psychological distress, negatively impacting normal childhood activities. Depression, anxiety disorders, and eating problems are commonly observed in this population. The study population consisted of 40 adolescents (22 females and 18 males) who had been diagnosed with T1D and 41 healthy adolescents (21 females and 20 males). The aim of this study was to compare adolescents with T1D to healthy controls in terms of depression, anxiety, and eating problems and subsequently examine the T1D group in relation to the risk of diabetes-specific eating disorders. Eating Attitudes Test (EAT-40), Revised Children's Anxiety and Depression Scale (RCADS), and Diabetes Eating Problem Survey- Revised (DEPS-R) scales were used to compare the case and control groups. The case group exhibited significantly higher scores in EAT-40 total score, RCADS parent form major depressive disorder (MDD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD), total anxiety score, total scale scores, RCADS child form MDD, PD, and total scale scores compared to the control group. Individuals at high risk of diabetes-specific eating disorder within the case group demonstrated significantly higher RCADS (child and parent form) MDD scores and RCADS parent form separation anxiety (SA) and total scale scores. Binary logistic regression analysis revealed that the RCADS parent form total scale score could predict DEPS-R. Routine screening of children and adolescents diagnosed with T1D for depression, anxiety, and eating disorder risk may facilitate early detection of possible psychopathologies, allowing for early intervention to address factors that may disrupt treatment adherence. Further longitudinal studies with larger samples are needed to investigate psychopathologies, particularly eating disorders, in children and adolescents with T1D.

Separation Anxiety among Kindergarten Children and its Association with Parental Socialization.

The present study aimed at investigating the association between separation anxiety and parental socialization styles among a sample of kindergarten children in Amman city, Jordan. The study adopted the descriptive cross-sectional design. A sample of 300 kindergarten children were enrolled in this study. The researcher used a modified version of the separation anxiety scale in addition to the parental socialization styles scale. Data were analyzed using the Statistical Package of Social Sciences (SPSS) (v. 27, IBM Corp.). The results of the study showed that 8% (n=24) of the enrolled participants had a high level of separation anxiety, normality parenting style was adopted by 38.7% (n=116). The results showed that there was significant statistical association between separation anxiety and cruelty parenting style (r=0.465, p=0.003), overprotection parenting style (r=0.301, p=0.000), negligence parenting style (p=0.641, p=0.04), and normality (r=0.09, p=0.000). The results showed that separation anxiety is significantly associated with parental socialization styles in general (r=0.326, p=0.007).

Median effective dose of esketamine for intranasal premedication in children with congenital heart disease

BackgroundEsketamine is commonly used as a premedication for its sedation effect. However, the proper dosage for intranasal use in children with congenital heart disease (CHD) has not been determined. This study aimed to estimate the median effective dose (ED50) of esketamine for intranasal premedication in children with CHD.MethodsThirty-four children with CHD who needed premedication in March 2021 were enrolled. Intranasal esketamine was initiated at a dose of 1 mg/kg. Based on the outcome of sedation in the previous patient, the dose for the subsequent patient was either increased or reduced by 0.1 mg/kg, which was adjusted between each child. Successful sedation was defined as a Ramsay Sedation Scale score ≥ 3 and Parental Separation Anxiety Scale score ≤ 2. The required ED50 of esketamine was calculated using the modified sequential method. Non-invasive blood pressure, heart rate, saturation of peripheral oxygen, sedation onset time, and adverse reactions were recorded at 5 min intervals after drug administration.ResultsThe 34 children enrolled had a mean age of 22.5 ± 16.4 (4–54) months and a mean weight of 11.2 ± 3.6 (5.5–20.5) kg; American Society of Anesthesiologists classification I–III. The ED50 of intranasal S(+)-ketamine (esketamine) required for preoperative sedation in pediatric patients with CHD was 0.7 (95% confidence interval: 0.54–0.86) mg/kg, and the mean sedation onset time was 16.39 ± 7.24 min. No serious adverse events, such as respiratory distress, nausea, and vomiting were observed.ConclusionsThe ED50 of intranasal esketamine was 0.7 mg/kg, which was safe and effective for preoperative sedation in pediatric patients with CHD.Trial registration: The trial was registered in the Chinese Clinical Trial Registry Network (ChiCTR2100044551) on 24/03/2021.

Separation anxiety and depression in caregivers of epileptic patients.

Epilepsy is a common neurological disorder affecting both the patients and the caregivers psychologically. Caregivers of these patients might have to face several challenges throughout the course of the disease. This study examines the correlations between the separation anxiety and depression of caregivers of adult and child epileptic patients according to their relation to the patients (parent vs. partner). 50 participants (caregivers of epileptic patients) were included. A sociodemographic form, Beck Depression (BDI) and Anxiety (BAI) Scales, and Adult Separation Anxiety (ASA) Scale were applied to the participants. 54% of the patients in the study had generalized seizures, whereas 46% had focal seizures. Our study has found the BAI of woman caregivers was higher compared to male caregivers. BAI and ASA were significantly higher for caregivers of patients with an illness duration lower than 5 years who were on multiple medications than for caregivers of patients who had an illness duration of more than 5 years who were on single medication (p<0.05). BDI, BAI and ASA scores were significantly higher in the generalized epilepsy group than in the focal epilepsy group (p<0.05). The ASA score was significantly higher in females than in males (p<0.05). The ASA score was significantly higher in the group with a low educational level than in the group with a high educational level (p<0.05) CONCLUSIONS: The findings of this study inform healthcare professionals regarding the needs of caregivers of epilepsy patients, especially around emotional problems. Results of this study demonstrate significant association between epilepsy seizure type, and separation anxiety and depression. Our study is the first study focused on the separation anxiety of the caregivers of epileptic patients. Separation anxiety has a negative impact on the personal independence of the caregiver.

Comparison of Efficacy of Child Cognitive – Behavioral Therapy (CCBT) Versus Family Cognitive – Behavioral Therapy (FCBT) and Mother - Child Attachment Intervention in Reduction of Separation Anxiety Disorder in Children between 7-12 Years Old

Objective: The purpose of this study was to compare and evaluate the effectiveness of child-based cognitive-behavioral therapy (CCBT), family-based cognitive-behavioral therapy (FCBT) and mother-child attachment intervention in reducing separation anxiety in children aged 7 to 12 years. Methods and Materials: The method of this semi-experimental study was pre-test-post-test with a control group and a three-month follow-up. For this purpose, 48 children with separation anxiety disorder were selected by purposive sampling and were divided into four groups of 12 people. The first group received child-based cognitive behavioral therapy, the second group received family-based cognitive behavioral therapy, the third group received mother-child attachment intervention, and the control group did not receive any intervention. The measurement tools of this research include the semi-structured diagnostic interview of mood disorders and schizophrenia for children and adolescents (K-SADS-PL) and Separation Anxiety Scale (Parental Form). The data were analyzed using mixed variance analysis with repeated measurement and Bonferroni's post hoc test. Findings: The findings show that child-centered cognitive-behavioral therapy has been more successful in reducing separation anxiety compared to family-centered cognitive-behavioral therapy and mother-child attachment-centered intervention. Also, family-centered cognitive-behavioral therapy has been more effective in reducing children's separation anxiety compared to mother-child attachment-centered intervention (P&lt;0.05). Conclusion: The results of the present study show that the therapeutic methods used can be effective in the treatment of separation anxiety disorder by psychologists and psychiatrists.

Cultural Adaptation of the Preschool Anxiety Scale in Romania

The current study investigated the psychometric proprieties of the Romanian form of the Preschool Anxiety Scale—Parent version (PAS). The sample consisted of 514 Romanian children (266 boys and 249 girls) aged 3 to 6 years. The mothers of these children completed the PAS and the Parenting Styles and Dimensions Questionnaire—Mother Form (PSDQ), and the children’s teachers completed the Behavior Assessment System for Children, Second Edition, Teacher Rating Scale (BASC-2 TRS). Results reveal that the PAS has satisfactory psychometric proprieties on the Romanian sample: it shows a good reliability and a good fit of the data with the underlying correlated five-factor structural model. The construct validity of the Romanian form of the PAS was supported by a significant relationship between the PAS total anxiety score and various BASC-2 (anxiety, withdrawal behavior, atypical behavior, learning problems, adaptability, social skills, learning skills, and leadership), and PSDQ (authoritarian, permissive, and authoritative parenting style) scales. Age had a significant effect on the generalized anxiety, physical injury fears and separation anxiety scales, and girls scored significantly higher than boys on the total anxiety score and the physical injury fears scale.

The effect of short music videos on needs satisfaction and separation anxiety of children's family members during COVID-19: The example of TikTok.

ObjectiveTo investigate the effect of short music videos on needs satisfaction and separation anxiety of the family members of children with congenital heart disease (CHD) in the cardiac intensive care unit (CICU) during the COVID-19 pandemic.MethodsEighty-seven children's family members were divided into the study group and the control group between February 2020 and March 2021. During the COVID-19 pandemic, the participants in the control group were visited by telephone, while the participants in the study group used the TikTok short music video application and WeChat as communication tools. After the intervention, the critical care family needs inventory (CCFNI) and separation anxiety scale (SAS) for all participants were recorded and analyzed.ResultsThere were no statistically significant differences in general characteristics or preintervention data between the two groups. However, the two dimensions of the support scale and information scale of the CCFNI in the study group were significantly different from those in the control group after the intervention (P = 0.008, and P = 0.021, respectively). There were significant differences in the three dimensions of the SAS between the two groups (P = 0.004, P = 0.007, and P = 0.041, respectively).ConclusionThe visiting system of the ICU changed during the COVID-19 pandemic, and the use of the TikTok short music video application and WeChat was conducive to optimizing the CICU ward visiting process, reducing the separation anxiety of the family members of children in the CICU, and improving their needs satisfaction.

Virtual Reality Glasses versus Midazolam in Alleviation of Child’s Anxiety during Dental Rehabilitation: Randomized Controlled Clinical Trial

Objective: To evaluate virtual reality glasses versus premedication with oral midazolam, and their effect on separation anxiety and postoperative behavioural changes in children experiencing dental rehabilitation under general anaesthesia. Introduction: Several children suffer anxiety when experiencing dental rehabilitation under general anaesthesia, which may be caused by separation from parents, and negative anticipation of surgical procedures. Midazolam (MDZ) is a generation of Benzodiazepines that have been widely used as a premedication. Whereas distraction is a common technique used to reduce pain and anxiety during short invasive procedures. Methodology: This was a randomized clinical trial; children aged 4-6 years who were healthy, uncooperative, and planned to be treated using general anaesthesia were randomly distributed between two groups (Group I), using the Virtual glasses and (Group II), given oral midazolam. The baseline heart rate (HR) was recorded twice. Ease of separation was assessed for all the participants using the Parental Separation Anxiety Scale (PSAS). The Postoperative behavioural changes were scored using (PHBQ) Questionnaire after 24 hours and 14 days after the operation. Results: Regression analysis showed that the type of intervention was non-significantly associated with the acceptability of separation. Males showed significantly less acceptable separation than females. There was a statistically significant increase in the heart rate readings in both groups when compared before and after separation. The parent-reported child morbidity following the surgery showed no significant difference except when regarding the children “who were upset at mentioning doctors, dentists or hospitals” where (P=0.000). Conclusion: VR and premedication with oral midazolam were both effective strategies for controlling preoperative anxiety in children during parental separation, with lots of advantages when using the VR distraction approach.

Effect of oral premedication of midazolam, ketamine, and dexmedetomidine on pediatric sedation and ease of parental separation in anesthesia induction for elective surgery

Objective: To compare effect of midazolam, dexmedetomidine, and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction. Methods: This multicenter, prospective, randomized, double-blind, clinical trial focused on a pediatric population aged 2-7 years (n=153) with the American Society of Anesthesiologists I-II who required elective surgery. The patients were stratified into three intervention groups: midazolam, ketamine, and dexmedetomidine. Hemodynamic parameters (blood pressure, heart rate, and oxygen saturation) every 5 min until induction of anesthesia along with non-hemodynamic factors, comprised of sedation score before the administration and at the time of being separated from the parents, as well as parental separation anxiety scale, acceptance of anesthesia induction, and side effects were recorded and compared. Results: No statistically significant difference in oxygen saturation, heart rate, blood pressure, duration of surgery, time to achieve an Aldrete score of 9-10, or sedation score was noted in the study groups. More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group (P=0.001). Moreover, fewer patients accept anesthesia induction (P=0.001) and more had side effects in the ketamine group (P=0.047). Conclusions: Our findings indicate that compared to the ketamine group, dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects. Dexmedetomidine and midazolam may be considered better choices. However, the final choice hinges on the patient's specific physical condition and the anesthesiologist's preference. Clinical registarion: This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.

ANXIETY IN THE NARRATIVES OF THE DISPLACED BY THE WAR POPULATION

1908 August war was short but claimed many lives. Thousands have been displaced due to combat and bombing. Separation from the native places had a long lasting and severe effect on the well-being of popula- tion. Qualitative study was carried out to describe and measure the emotional reaction to war and displacement.&nbsp; Analysis of 5 minutes length narratives of the displaced population registered after 10 and 15 months from&nbsp; displacement by Gottshalk-Gleser method revealed high level of six types of anxiety measured by scales. The&nbsp; comparison of anxiety scores over time points at the persistence of negative emotional state induced by the war&nbsp; and at the importance of displacement, reflected both in number of references to displacement and separation&nbsp; anxiety scale scores.

Role of nebulised dexmedetomidine, midazolam or ketamine as premedication in preschool children undergoing general anaesthesia-A prospective, double-blind, randomised study.

ABSTRACTBackground and Aims:Preschool age children are psycho-biologically vulnerable to all surgical procedures. In this study, we investigated the effect of nebulised dexmedetomidine, midazolam and ketamine as sedative premedication for alleviating parental separation anxiety, facilitating face mask acceptance and reducing emergence agitation in paediatric patients undergoing general anaesthesia.Methods:A prospective, randomised, double-blind study was done involving 96 children of age 3–7 years, randomly allocated into three equal groups and pre-medicated with either nebulised dexmedetomidine 2 mg/kg (GroupD), midazolam 0.2 mg/kg (GroupM) or ketamine 2 mg/kg (Group K). The scores of sedation scale, parental separation anxiety scale, mask acceptance scale and emergence agitation scale were recorded along with haemodynamic parameters. Two-way repeated measures analysis of variance (ANOVA), post hoc test and Kruskal–Wallis test were used for statistical analysis.Results:A statistically significant difference in sedation score was seen between the different study groups, χ2(2) = 8.561, P = 0.014 with mean rank sedation score of 56.50 for Group D, 38.92 for Group M and 43.84 for Group K. Parental separation anxiety scale score and Mask acceptance scale score also showed statistically significant difference between the different study groups, χ2(2) = 9.369, P = 0.009 and χ2(2) = 11.97, P = 0.003, respectively.Conclusion:Nebulisation with dexmedetomidine produced easy parental separation, more satisfactory sedation and face mask acceptance with less postoperative agitation than nebulisation with midazolam or ketamine.

Comparison of intranasal dexmedetomidine and oral midazolam as premedication for cochlear implant surgery in children

Background: Children undergoing surgical procedures can experience significant anxiety and distress during the perioperative period. The use of sedative premedication may help to reduce anxiety, minimize the emotional trauma, and facilitate a smooth induction of anesthesia. Midazolam is most commonly used as a premedication agent in children. Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist that provides sedation, anxiolysis, and analgesic effects without causing respiratory depression. Aims and Objectives: The aim of the study was to compare intranasally administered dexmedetomidine and oral midazolam for premedication in pediatric patients undergoing cochlear implant surgeries. Materials and Methods: This prospective randomized controlled study included 60 ASA Grade I and II patients between 1 and 6 years of age who underwent cochlear implant surgeries under general anesthesia. Patients were divided into two groups. Group A received 1μg/kg intranasal dexmedetomidine and Group B patients received 0.5 mg/kg oral midazolam 45 min before induction. The pediatric separation anxiety was assessed using the pediatric separation anxiety scale (PSAS) while shifting the patient to operating room (OR) and mask acceptance was assessed by the attending anesthesiologist using mask acceptance scale (MAS) in OR who is blinded to the drug given. Heart rate (HR) and oxygen saturation were monitored till the end of procedure was noted on a pre-structured proforma. Results: The mean PSAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.10±0.31 (P=0.000). The mean MAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.13±0.35 (P=0.000). Mean HR (P&gt;0.05), systolic blood pressure (P&gt;0.05), and diastolic blood pressure (P&gt;0.05) were comparable between both the groups. There was a statistically significant association seen between sedation grade and the groups (P=0.000), showing that groups are dependent on the sedation group. There was a statistically significant association seen between wake up behavior grade and the groups (P=0.000), showing that groups are dependent on the wake up behavior grade. Conclusion: Intranasal dexmedetomidine is an effective and safe alternative for premedication in view of parental separation, mask acceptance, hemodynamic stability, and sedation for the children undergoing cochlear implant surgeries under general anesthesia.

Validation of the Children's Separation Anxiety Scale - Parent Version (CSAS-P).

The main objective of this research was to validate the parents’ version of the Children’s Separation Anxiety Scale (CSAS-P), which assesses separation anxiety symptoms in pre-adolescence, the stage with the highest incidence of anxiety disorder due to separation. In Study 1, 1,089 parents, those children aged between 8 and 11 (M = 9.59, SD = 1.11), 51.7% girls, were selected by random cluster sampling, who completed the CSAS-P to obtain the factorial structure. Exploratory factor analysis identified four related factors: Worry, Opposition, Calm, and Distress, which explained 42.93% of the variance. In Study 2, 3,801 parents, those children aged between 8 and 11 (M = 9.50, SD = 1.10), 50.2% girls, completed the CSAS-P, and their children completed the Children’s Separation Anxiety Scale (CSAS). The four related-factor model from Study 1 was validated by confirmatory factor analysis. The CSAS-P had adequate internal consistency (α = 0.84), temporal stability (r = 0.72), and invariance across children’s age and gender and the parent who completed the scale. Age and gender differences were small: older children scored higher on Worry and younger children on Distress; the girls scored higher on all factors. Small differences were also found depending on the parent who completed the scale without finding a clear pattern. Parents scored significantly lower than the child on all four factors of the scale. The results support the reliability and validity of the CSAS-P, an instrument that complements the child’s self-report in the framework of the multi-source assessment.

Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial.

BackgroundAllaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia.Methods Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study's primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events.ResultsThe median Ramsay sedation scale at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients.

126 Are Burn-injured Youth Anxiety Disorders Being Missed Because Parents Are Unaware of the Problem?

IntroductionAnxiety disorders among pediatric burn survivors have been shown to be common in both the acute care and outpatient settings. However, there is a paucity of research regarding parental awareness of psychological issues affecting burn-injured Dallas & adolescents. This study examined the relationship between burn-injured youths’ self-reported anxiety levels, as compared to their parent’s perceptions.MethodsParents of burn injured Dallas were invited to complete the Parent Version of the 41-item survey, Screen for Child Anxiety Related Disorders (SCARED) which consists of five anxiety sub-scales as well as a Total Anxiety Score. Their Dallas also voluntarily complete the Child Version. A higher score indicates greater anxiety.ResultsForty-five parent-child dyads, with girls (51%) and boys (49%), completed surveys Ethnicity was reported as Caucasian (36%) Hispanic (42%) African Am (18%). Mothers (78%) fathers (18%) grandmothers (2%) & guardian (2%) participated. Mean parent age was 39. Child mean age was 13. Burn scars were visible in 64% of Dallas. Matched-pairs t-tests were used to compare parent and child scores. Parents reported lower SCARED Total Anxiety scores (mean=10.52) than youth (21.06), p< 0.001. Parents also reported significantly lower scores on the Panic Disorder/ Somatic Symptoms (p< 0.001), Generalized Anxiety Disorder (p=.004), Separation Anxiety (p< 0.001), and School Avoidance subscale (p< 0.001). For the Separation Anxiety scale, 23 youth’s self-report exceeded the threshold for suspected disorder, while parent report classified only 3 with separation anxiety. Spearman correlations between parent and youth scale scores yielded no significant results (all less than rs =.20, p >0.25), indicating virtually no association between the two.ConclusionsResults reveal a lack of parental awareness of their child’s anxiety disorder symptomology. This lack of recognition is of concern because Dallas are dependent on their parents/caregivers to identify psychopathologies and to help them seek services for mental health challenges.

The effect of using tablet computer on surgical stress: A single-blinded randomized controlled trial

The purpose of our study was to evaluate the effects of tablet computer method on children with and without anxiety. The study was designed as a prospective single-blinded randomized controlled trial. The population of the study were 300 patients between the ages of 4 and 10 years old who were scheduled for their first elective surgery for phimosis-inguinal hernia-hydrocele-undescended testis-hypospadias. The initial anxiety scores of the patients were evaluated using modified-Yale Preoperative Anxiety Scale (mYPAS). Group-Midazolam, Group-Tablet, Group-Control were formed by applying randomization to the patients. The anxiety levels of the patients were evaluated in the waiting room using mYPAS after 0.5mg/kg midazolam or tablet computer. Patient anxiety about separation from their families was evaluated with Parental Separation Anxiety Scale (PSAS), and reactions to the anaesthesia mask were evaluated with Mask Acceptance Scale (MAS). Also, the time spent by the patients in the Post-Operative Care Unit (PACU) was evaluated. Post-Hospitalization Behavior Questionnaire (PHBQ) scores of the patients were determined by the anesthesiologist one week after the surgery. The study compared the anxiety levels in groups. There were significant differences in the post-anxiolytic-mYPAS-scores and percentages of decrease from the preoperative baseline measurements (p<0.001 and p<0.001). There were significantly more children who were easily separated from their parents (PSAS-Score 1) in Group-Midazolam (p<0.01). The children in Group-Midazolam also accepted the masks more readily (MAS-Score 1) than other (p<0.001). Differences in the duration of the recovery time and mean PHBQ-scores between the groups were also significant (p<0.001 for each). For children with anxiety, the recovery time for those in Group-Midazolam was significantly longer than other. For children without anxiety (p<0.001), the duration of the recovery time in Group-Midazolam was also found to be significantly longer than other. The PHBQ-scores of the children in Group-Control with anxiety and without anxiety were significantly higher than other (p<0.05 for each). Also, there were significant differences in the distribution of the PSAS-scores between the children with and without anxiety. Anxiety had no impact on the distribution of the MAS-scores (p=0.045 and p=0.100). Playing tablet-based games in the preoperative period enabled pediatric patients to be more comfortable while waiting in their rooms, leaving their families, and applying an anaesthetic mask. In pediatric patient with and without anxiety, midazolam separation from the family and accepting the anesthesia mask is easiest in midazolam, second in those who are given a tablet computer.