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Martin KD, Van Buren JP, Wake J, Dawson L. Comparison of Visual Analog Pain Score Reported to Physician vs Nurse. Foot Ankle Int 2018; 39:300-303. [PMID: 29160755 DOI: 10.1177/1071100717740584] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The visual analog scale (VAS) is considered a reliable and validated measure of patient-reported acute pain. Patient-reported outcome measures are becoming the standard of care throughout the orthopedic community, but interpretation and clinical applications are still under investigation. The aim of the current study was to compare preoperative patient-reported VAS scores reported at the same visit to nursing staff and the treating surgeon. Our hypothesis was that there would be no difference in the scores reported. METHODS This study is a retrospective cohort of 201 consecutive foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from "no pain" to the "worst pain." Differences in reported pain values were analyzed. RESULTS The results demonstrate that patients reported higher pain scores to the surgeon in 81% of the encounters, nursing staff 8%, and equal 11%. On average, the VAS score reported to the surgeon was significantly ( P < .05) higher than that reported to the nursing staff. CONCLUSION The current study found a statistically significant higher patient-reported pain score to the treating surgeon compared to the nursing staff. While the exact cause is unclear, the discrepant pain scores call into question the validity of the VAS, considered a fifth vital sign and standard outcome measure in an outpatient clinic setting. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
| | - J Preston Van Buren
- 2 Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Jeffrey Wake
- 2 Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Laura Dawson
- 3 Keller Army Community Hospital, West Point, NY, USA
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Pomicino L, Maccacari E, Buchini S. Levels of anxiety in parents in the 24 hr before and after their child's surgery: A descriptive study. J Clin Nurs 2017; 27:278-287. [DOI: 10.1111/jocn.13895] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Pomicino
- Pediatric Oncology and Hematology Department; Institute for Maternal and Child Health-IRCCS Burlo Garofolo; Trieste Italy
| | - Elena Maccacari
- Pediatric Intensive Care Unit; St George's University Hospitals-NHS Foundation Trust; London UK
| | - Sara Buchini
- Unit of Research and Professional; Organizational Development of Health Professionals; Institute for Maternal and Child Health-IRCCS Burlo Garofolo; Trieste Italy
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Berghmans JM, Poley MJ, van der Ende J, Weber F, Van de Velde M, Adriaenssens P, Himpe D, Verhulst FC, Utens E. A Visual Analog Scale to assess anxiety in children during anesthesia induction (VAS-I): Results supporting its validity in a sample of day care surgery patients. Paediatr Anaesth 2017; 27:955-961. [PMID: 28707384 DOI: 10.1111/pan.13206] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The modified Yale Preoperative Anxiety Scale is widely used to assess children's anxiety during induction of anesthesia, but requires training and its administration is time-consuming. A Visual Analog Scale, in contrast, requires no training, is easy-to-use and quickly completed. AIM The aim of this study was to evaluate a Visual Analog Scale as a tool to assess anxiety during induction of anesthesia and to determine cut-offs to distinguish between anxious and nonanxious children. METHODS Four hundred and one children (1.5-16 years) scheduled for daytime surgery were included. Children's anxiety during induction was rated by parents and anesthesiologists on a Visual Analog Scale and by a trained observer on the modified Yale Preoperative Anxiety Scale. Psychometric properties assessed were: (i) concurrent validity (correlations between parents' and anesthesiologists' Visual Analog Scale and modified Yale Preoperative Anxiety Scale scores); (ii) construct validity (differences between subgroups according to the children's age and the parents' anxiety as assessed by the State-Trait Anxiety Inventory); (iii) cross-informant agreement using Bland-Altman analysis; (iv) cut-offs to distinguish between anxious and nonanxious children (reference: modified Yale Preoperative Anxiety Scale ≥30). RESULTS Correlations between parents' and anesthesiologists' Visual Analog Scale and modified Yale Preoperative Anxiety Scale scores were strong (0.68 and 0.73, respectively). Visual Analog Scale scores were higher for children ≤5 years compared to children aged ≥6. Visual Analog Scale scores of children of high-anxious parents were higher than those of low-anxious parents. The mean difference between parents' and anesthesiologists' Visual Analog Scale scores was 3.6, with 95% limits of agreement (-56.1 to 63.3). To classify anxious children, cut-offs for parents (≥37 mm) and anesthesiologists (≥30 mm) were established. CONCLUSIONS The present data provide preliminary data for the validity of a Visual Analog Scale to assess children's anxiety during induction.
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Affiliation(s)
- Johan M Berghmans
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Anesthesia, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marten J Poley
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Frank Weber
- Department of Anesthesia, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, KU Leuven, University Hospital Gasthuisberg, Leuven, Belgium
| | - Peter Adriaenssens
- Department of Child Psychiatry, KU Leuven, University Hospital Gasthuisberg, Leuven, Belgium
| | - Dirk Himpe
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam/de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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Sola C, Lefauconnier A, Bringuier S, Raux O, Capdevila X, Dadure C. Childhood preoperative anxiolysis: Is sedation and distraction better than either alone? A prospective randomized study. Paediatr Anaesth 2017. [PMID: 28620924 DOI: 10.1111/pan.13180] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preoperative anxiety management receives special attention in pediatric anesthesia. Different pharmacological and nonpharmacological techniques can be employed. This study was designed to assess three different strategies for childhood preoperative anxiolysis: midazolam premedication, midazolam in combination with portable Digital Video-Disk player, or video distraction strategy alone. METHODS In this prospective randomized study, children aged 2-12 years were assigned to one of the three study groups. The primary outcome was a change in preoperative children's anxiety, from baseline (before transfer to the preanesthetic holding area) to separation from parents, assessed by the Modified Yale Preoperative Anxiety Scale (mYPAS) and the Visual Analog Anxiety Scale (VAS-Anxiety). Delirium emergence, postoperative pain, and parental satisfaction were also collected. RESULTS One hundred and thirty-five patients were enrolled. The three preventive strategies allowed control of preoperative distress. Within the three study groups, no significant change was objectified in the anxiety level from baseline to separation from parents (mean change in mYPAS midazolam group: 2.4 95% CI [-1.7 to 6.3]; midazolam+Digital Video-Disk group: -1.0 95% CI [-5.9 to 3]; and Digital Video-Disk group: 1.4 95% CI [-4 to 6.7]). Comparison of change in preoperative children's anxiety between the groups did not show any difference. Emergence delirium, postoperative pain scores, and analgesic consumption were similar between the groups and parents' satisfaction was excellent. CONCLUSION Both pharmacological premedication and video distraction are effective strategies for controlling preoperative childhood anxiety. The combination of midazolam and Digital Video-Disk player was not better than either alone.
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Affiliation(s)
- Chrystelle Sola
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Audrey Lefauconnier
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Sophie Bringuier
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Olivier Raux
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Xavier Capdevila
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Christophe Dadure
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
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Duparc-Alegria N, Tiberghien K, Abdoul H, Dahmani S, Alberti C, Thiollier AF. Assessment of a short hypnosis in a paediatric operating room in reducing postoperative pain and anxiety: A randomised study. J Clin Nurs 2017; 27:86-91. [PMID: 28403569 DOI: 10.1111/jocn.13848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To assess the impact of a short hypnotic session on postoperative anxiety and pain in major orthopaedic surgery. BACKGROUND Despite specific information given before a scheduled paediatric surgery, perioperative anxiety can become important. DESIGN Randomised Clinical Study. METHODS The study is an open single-centre randomised clinical study comparing a "control" group versus a "hypnosis" group receiving a short hypnosis pre-induction session as additional experimental analgesic procedure. The primary endpoint was the postoperative anxiety, blindly assessed using a visual analogue scale. RESULTS The study involved 120 children (age 10-18 years). The results showed no difference between control group versus hypnosis group. Twenty-four hours after surgery (Day+1), the patient's anxiety score was not different between control and hypnosis groups (median [Q1-Q3]: 1 [0; 3] vs. 0 [0; 3], respectively, p = .17). Each group experienced a significant decrease in anxiety level between the day before surgery (Day-1) and the day after surgery (Day+1) (median ([Q1-Q3]) difference of the anxiety score: 2 [4; 0] and 2 [4; 0], respectively, p < .0001 in each group). The postoperative pain scores were low and not different between groups (median [Q1-Q3]: 2 [0; 3] in control group vs. 3 [1; 3] in hypnosis group, p = .57). CONCLUSION This randomised study on a short hypnosis session performed in the operating room prior to a major surgery showed no difference in postoperative anxiety and pain levels. The decrease in anxiety and pain levels may be due to the addition of nurse pre-operative interviews and optimisation in communication in the operating room. RELEVANCE TO CLINICAL PRACTICE As postoperative anxiety level was low in both control and hypnosis groups, nurse pre-operative interviews and nurse training in hypnosis may contribute to the optimisation of global management and decrease the postoperative anxiety level.
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Affiliation(s)
- Nathalie Duparc-Alegria
- Pain Management Unit, Department of Anaesthesiology, AP-HP, Hôpital Robert-Debré, Paris, France
| | - Karine Tiberghien
- Pain Management Unit, Department of Anaesthesiology, AP-HP, Hôpital Robert-Debré, Paris, France
| | - Hendy Abdoul
- Unit of Clinical Epidemiology and CIC-EC 1456, AP-HP, Hôpital Robert-Debré, Paris, France.,Univ. Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, Paris, France
| | - Souhayl Dahmani
- Pain Management Unit, Department of Anaesthesiology, AP-HP, Hôpital Robert-Debré, Paris, France.,Univ. Paris Diderot, Sorbonne Paris Cité, UMR-S 1141, DHU Protect, Paris, France.,INSERM, U1141, DHU Protect, Paris, France
| | - Corinne Alberti
- Unit of Clinical Epidemiology and CIC-EC 1456, AP-HP, Hôpital Robert-Debré, Paris, France.,Univ. Paris Diderot, Sorbonne Paris Cité, UMR-S 1123, Paris, France.,INSERM, U1123, ECEVE and CIC-EC 1456, Paris, France
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56
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Bellon M, Taillardat E, Hörlin AL, Delivet H, Brasher C, Hilly J, Dahmani S. Validation of a simple tool for anxiety trait screening in children presenting for surgery. Br J Anaesth 2017; 118:910-917. [PMID: 28520894 DOI: 10.1093/bja/aex120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background. Screening for preoperative anxiety is an important challenge during the preoperative period. The aim of our study was to validate the faces scale used to detect anxiety trait in children. Methods. Children aged 8-18 yr were asked to quantify their anxiety trait using the readily available faces scale and to respond to the trait component of the State-Trait Anxiety Inventory (STAI) for children (C) or adults (A) before the anaesthesia consultation. Using receiver operating characteristics analysis, we determined the faces scale optimal value on a construct cohort. A validation cohort was recruited to assess the accuracy of the results. Results. The construction cohort comprised 207 patients and the validation cohort 91 patients. The receiver operating characteristics analysis found an area under the curve of 0.75 [95% confidence interval (CI) 0.67, 0.83]. The optimal value for faces scale score was 4, with a sensitivity of 0.61 [95% CI 0.59, 0.62] and a specificity of 0.82 [95% CI 0.81, 0.83]. When this threshold was applied to the construction and validation cohorts, 61.3 and 44.4% of positives were true positives in the construction and validation cohorts, respectively; and 82.1 and 81.3% of negatives were true negatives, respectively. Conclusions. Our study determined the performance of a simple faces scale to measure the preoperative anxiety trait in children aged 8-18 yr. This tool is potentially helpful for clinicians aiming to identify patients at risk of preoperative anxiety and to assign them to targeted management.
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Affiliation(s)
- M Bellon
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France
| | - E Taillardat
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France
| | - A-L Hörlin
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France
| | - H Delivet
- Department of Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,René Descarte University, Paris V, 71 avenue Edouard Vaillant, 92774 Boulogne-Billancourt Cedex, France
| | - C Brasher
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - J Hilly
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France
| | - S Dahmani
- Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.,Denis Diderot University, Paris VII, 10 avenue de Verdun, Paris, France.,Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
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Chidambaran V, Zhang X, Martin LJ, Ding L, Weirauch MT, Geisler K, Stubbeman BL, Sadhasivam S, Ji H. DNA methylation at the mu-1 opioid receptor gene ( OPRM1) promoter predicts preoperative, acute, and chronic postsurgical pain after spine fusion. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2017; 10:157-168. [PMID: 28533693 PMCID: PMC5432115 DOI: 10.2147/pgpm.s132691] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction The perioperative pain experience shows great interindividual variability and is difficult to predict. The mu-1 opioid receptor gene (OPRM1) is known to play an important role in opioid-pain pathways. Since deoxyribonucleic acid (DNA) methylation is a potent repressor of gene expression, DNA methylation was evaluated at the OPRM1 promoter, as a predictor of preoperative, acute, and chronic postsurgical pain (CPSP). Methods A prospective observational cohort study was conducted in 133 adolescents with idiopathic scoliosis undergoing spine fusion under standard protocols. Data regarding pain, opioid consumption, anxiety, and catastrophizing (using validated questionnaires) were collected before and 2–3 months postsurgery. Outcomes evaluated were preoperative pain, acute postoperative pain (area under curve [AUC] for pain scores over 48 hours), and CPSP (numerical rating scale >3/10 at 2–3 months postsurgery). Blood samples collected preoperatively were analyzed for DNA methylation by pyrosequencing of 22 CpG sites at the OPRM1 gene promoter. The association of each pain outcome with the methylation percentage of each CpG site was assessed using multivariable regression, adjusting for significant (P<0.05) nongenetic variables. Results Majority (83%) of the patients reported no pain preoperatively, while CPSP occurred in 36% of the subjects (44/121). Regression on dichotomized preoperative pain outcome showed association with methylation at six CpG sites (1, 3, 4, 9, 11, and 17) (P<0.05). Methylation at CpG sites 4, 17, and 18 was associated with higher AUC after adjusting for opioid consumption and preoperative pain score (P<0.05). After adjusting for postoperative opioid consumption and preoperative pain score, methylation at CpG sites 13 and 22 was associated with CPSP (P<0.05). Discussion Novel CPSP biomarkers were identified in an active regulatory region of the OPRM1 gene that binds multiple transcription factors. Inhibition of binding by DNA methylation potentially decreases the OPRM1 gene expression, leading to a decreased response to endogenous and exogenous opioids, and an increased pain experience.
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Affiliation(s)
| | - Xue Zhang
- Division of Human Genetics.,Pyrosequencing Core for Genomic and Epigenomic Research
| | - Lisa J Martin
- Department of Pediatrics.,Division of Human Genetics
| | - Lili Ding
- Division of Biostatistics and Epidemiology
| | - Matthew T Weirauch
- Center for Autoimmune Genomics and Etiology.,Division of Biomedical Informatics.,Division of Developmental Biology
| | | | | | | | - Hong Ji
- Pyrosequencing Core for Genomic and Epigenomic Research.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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58
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European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017; 34:192-214. [DOI: 10.1097/eja.0000000000000594] [Citation(s) in RCA: 491] [Impact Index Per Article: 70.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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59
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Chidambaran V, Ding L, Moore DL, Spruance K, Cudilo EM, Pilipenko V, Hossain M, Sturm P, Kashikar-Zuck S, Martin LJ, Sadhasivam S. Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study. Eur J Pain 2017; 21:1252-1265. [PMID: 28346762 DOI: 10.1002/ejp.1025] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) affects half a million children annually in the United States, with dire socioeconomic consequences, including long-term disability into adulthood. The few studies of CPSP in children are limited by sample size, follow-up duration, non-homogeneity of surgical procedure and factors evaluated. METHODS In a prospective study of 144 adolescents undergoing a single major surgery (spine fusion), we evaluated demographic, perioperative, surgical and psychosocial factors as predictors of a continuum of postsurgical pain: immediate, pain maintenance at 2-3 months (chronic pain/CP) and persistence of pain a year (persistent pain/PP) after surgery. RESULTS We found an incidence of 37.8% and 41.8% for CP and PP. CP and acute pain were both significant predictors for developing PP (p-value <0.001 and 0.003). Preoperative pain and higher postoperative opioid requirement was significantly associated with CP (p = 0.015, p = 0.002), while Childhood Anxiety Sensitivity Index (p = 0.002) and surgical duration (p = 0.014) predicted PP. The final regression models had reasonable predictive accuracy (c-statistic of 0.73 and 0.83 for CP and PP, respectively). Anxiety scores and catastrophizing for child and parent were found to be significantly correlated (p = 0.005, p = 0.013 respectively). Pain trajectories revealed that 65% of patients who developed PP reported CP and high pain trends; however, 33% of those who developed PP could not be identified using solely pain criteria. CONCLUSION Persistent postsurgical pain in children is a significant problem. It can be predicted in part by combinations of psychological and clinical variables, which may provide evidence-based measures to prevent development of CPSP in the future. SIGNIFICANCE In a homogeneous cohort of adolescents undergoing spine fusion, we report a high incidence of persistent postsurgical pain (41.8%) predicted by child anxiety, perioperative pain, and surgical duration. Our results stress timely preventive and therapeutic strategies.
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Affiliation(s)
- V Chidambaran
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA
| | - L Ding
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA
| | - D L Moore
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA
| | - K Spruance
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA
| | - E M Cudilo
- Pediatric Anesthesia Associates Medical Group Fresno, CA
| | - V Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital, USA
| | - M Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA
| | - P Sturm
- Division of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, USA
| | - S Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - L J Martin
- Division of Human Genetics, Cincinnati Children's Hospital, USA
| | - S Sadhasivam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA
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Oates A, Benedict KA, Sun K, Brakeman PR, Lim J, Kim C. Laser acupuncture reduces pain in pediatric kidney biopsies: a randomized controlled trial. Pain 2017; 158:103-109. [PMID: 27749608 PMCID: PMC5234680 DOI: 10.1097/j.pain.0000000000000734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evaluate laser acupuncture (LA) as an adjuvant therapy in pain management during percutaneous kidney biopsy procedure in children and adolescents. This prospective, double-blinded, randomized controlled trial enrolled patients aged 7 to 26 years admitted to a children's hospital for percutaneous kidney biopsy. Patients received LA to treatment points (acupuncture group) or sham points (control group) before the procedure. The laser delivered a dose of 42 J/cm over 10 acupoints. Patients and parents rated the pain during and after the biopsy, and change in pain scores were calculated for each patient. Anxiety, vital signs, sedation medication, and patient's biopsy experience were secondary outcomes. Sixty-nine treatments (33 in the acupuncture group and 36 in the control group) were eligible for analysis. Patients in the acupuncture group reported a significantly improved change in the pain score after the biopsy compared with the controls (0.8 vs -0.5, P = 0.044). Patients in the acupuncture group had a statistically significant decrease in procedure vital signs including heart rate (-1.8 vs 5.6, P = 0.043) and respiratory rate (-2.4 vs 0.4, P = 0.045) when compared with controls. Parents also perceived a correspondingly greater improvement in their child's pain for those in the acupuncture group compared with the controls (2.3 vs 0.3, P = 0.04). Adjunctive LA significantly improved pain after pediatric percutaneous kidney biopsies.
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Affiliation(s)
- Aris Oates
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Kelly A Benedict
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Karen Sun
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Paul R Brakeman
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Jessica Lim
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Cynthia Kim
- UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
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Jerez C, Lázaro JJ, Ullán AM. [Evaluation of the scales used to measure anxiety and child behaviour during the induction of anaesthesia. Literature review]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:101-107. [PMID: 26162900 DOI: 10.1016/j.redar.2015.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 06/04/2023]
Abstract
The assessment of children's anxiety during anaesthetic induction is useful to determine if pre-operative strategies have been effective in reducing anxiety. The aim of this study is to review the different tools used to evaluate child anxiety or behaviour during the induction of anaesthesia. The electronic databases with no date limits were reviewed in December 2013, with a second review repeated in September 2014. A data extraction template was applied to find the scales used in the articles. Eight observational scales were found. Six of them can only be used during induction of anaesthesia, and two of those could be applied at various perioperative times, before surgery and during induction of anaesthesia.
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Affiliation(s)
- C Jerez
- Departamento de Anestesiología y Reanimación, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - J J Lázaro
- Departamento de Anestesiología y Reanimación, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - A M Ullán
- Facultad de Ciencias Sociales, Universidad de Salamanca, Campus Miguel de Unamuno, Salamanca, España
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Quan X, Joseph A, Nanda U, Moyano-Smith O, Kanakri S, Ancheta C, Loveless EA. Improving Pediatric Radiography Patient Stress, Mood, and Parental Satisfaction Through Positive Environmental Distractions: A Randomized Control Trial. J Pediatr Nurs 2016; 31:e11-22. [PMID: 26395650 DOI: 10.1016/j.pedn.2015.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/18/2022]
Abstract
UNLABELLED To evaluate how a positive environmental distraction intervention impacted pediatric radiography patient behavioral stress-responses, mood states, and parental satisfaction. METHODS Behavioral observation, rating scales, surveys on 182 pediatric patients and their parents randomly assigned to three positive distraction levels (minimum, light, light and animation). RESULTS Under interventional conditions, patients exhibited less low-stress coping behaviors (ps<0.001-0.007) and more verbal behaviors indicating positive affect (p=0.003); parents more favorably rated environmental pleasantness (ps<0.001), sense of environmental control (ps=0.002), and willingness to return and recommend the facility (ps=0.001-0.005). CONCLUSION The intervention improved pediatric radiography experience but needs further investigation in more stressful settings.
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Jerez C, Ullán AM, Lázaro JJ. Reliability and validity of the Spanish version of the modified Yale Preoperative Anxiety Scale. ACTA ACUST UNITED AC 2015; 63:320-6. [PMID: 26633606 DOI: 10.1016/j.redar.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE To minimise preoperative stress and increase child cooperation during induction of anaesthesia is one of the most important perioperative objectives. The modified Yale Preoperative Anxiety Scale was developed to evaluate anxiety. The aim of this study was to translate into Spanish, and validate the psychometric properties of the Spanish version of this scale. MATERIAL AND METHODS The Spanish translation of the scale was performed following the World Health Organisation guidelines. During induction of anaesthesia, 81 children aged 2 to 12 years were recorded. Two observers evaluated the recordings independently. Content validity index of modified Yale Preoperative Anxiety Scale Spanish version was assessed. Weighted Kappa was calculated to measure interobserver agreement, and the Pearson correlation between the Induction Compliance Checklist and the modified Yale Preoperative Anxiety Scale was determined. RESULTS The Spanish version obtained high content validity (0.91 to 0.98). Reliability analysis using weighted Kappa statistics revealed that interobserver agreement ranged from 0.54 to 0.75. Concurrent validity was high (r=0.94; P<.001). CONCLUSIONS Validated assessment tools are needed to evaluate interventions to reduce child preoperative anxiety. The Spanish version of the modified Yale Preoperative Anxiety Scale evaluated in this study has shown good psychometric properties of reliability and validity.
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Affiliation(s)
- C Jerez
- Unidad de Cirugía Ambulatoria, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - A M Ullán
- Facultad de Ciencias Sociales, Universidad de Salamanca, Campus Miguel de Unamuno, Salamanca, España
| | - J J Lázaro
- Departamento de Anestesiología y Reanimación, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Zavras N, Tsamoudaki S, Ntomi V, Yiannopoulos I, Christianakis E, Pikoulis E. Predictive Factors of Postoperative Pain and Postoperative Anxiety in Children Undergoing Elective Circumcision: A Prospective Cohort Study. Korean J Pain 2015; 28:244-53. [PMID: 26495079 PMCID: PMC4610938 DOI: 10.3344/kjp.2015.28.4.244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although circumcision for phimosis in children is a minor surgical procedure, it is followed by pain and carries the risk of increased postoperative anxiety. This study examined predictive factors of postoperative pain and anxiety in children undergoing circumcision. METHODS We conducted a prospective cohort study of children scheduled for elective circumcision. Circumcision was performed applying one of the following surgical techniques: sutureless prepuceplasty (SP), preputial plasty technique (PP), and conventional circumcision (CC). Demographics and base-line clinical characteristics were collected, and assessment of the level of preoperative anxiety was performed. Subsequently, a statistical model was designed in order to examine predictive factors of postoperative pain and postoperative anxiety. Assessment of postoperative pain was performed using the Faces Pain Scale (FPS). The Post Hospitalization Behavior Questionnaire study was used to assess negative behavioral manifestations. RESULTS A total of 301 children with a mean age of 7.56 ± 2.61 years were included in the study. Predictive factors of postoperative pain measured with the FPS included a) the type of surgical technique, b) the absence of siblings, and c) the presence of postoperative complications. Predictive factors of postoperative anxiety included a) the type of surgical technique, b) the level of education of mothers, c) the presence of preoperative anxiety, and d) a history of previous surgery. CONCLUSIONS Although our study was not without its limitations, it expands current knowledge by adding new predictive factors of postoperative pain and postoperative anxiety. Clearly, further randomized controlled studies are needed to confirm its results.
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Affiliation(s)
- Nick Zavras
- 3 Department of Surgery, General University Hospital "ATTIKON", Athens, Greece
| | | | - Vasileia Ntomi
- 3 Department of Surgery, General University Hospital "ATTIKON", Athens, Greece
| | | | | | - Emmanuel Pikoulis
- 1 Department of General Surgery, General University Hospital "LAIKO", Athens, Greece
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Stinley NE, Norris DO, Hinds PS. Creating Mandalas for the Management of Acute Pain Symptoms in Pediatric Patients. ART THERAPY 2015. [DOI: 10.1080/07421656.2015.1028871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lee JS, Park YM, Ha KY, Cho SW, Bak GH, Kim KW. Preoperative anxiety about spinal surgery under general anesthesia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:698-707. [PMID: 25670066 DOI: 10.1007/s00586-015-3788-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE No study has investigated preoperative anxiety about spinal surgery under general anesthesia. The purposes of this study were (1) to determine how many patients have preoperative anxiety about spinal surgery and general anesthesia, (2) to evaluate the level of anxiety, (3) to identify patient factors potentially associated with the level of anxiety, and (4) to describe the characteristics of the anxiety that patients experience during the perioperative period. METHODS This study was performed in 175 consecutive patients undergoing laminectomy for lumbar stenosis or discectomy for herniated nucleus pulposus under general anesthesia. Demographic data, information related to surgery, and characteristics of anxiety were obtained using a questionnaire. The level of anxiety was assessed using a visual analog scale of anxiety (VAS-anxiety). Patient factors potentially associated with the level of anxiety were investigated using multiple stepwise regression analysis. RESULTS Of 157 patients finally included in this study, 137 (87%) had preoperative anxiety (VAS-anxiety > 0). The mean VAS-anxiety score for spinal surgery was significantly higher than that for general anesthesia (4.6 ± 3.0 vs. 3.2 ± 2.7; P < 0.001). Sex and age were significant patient factors related to the level of anxiety about spinal surgery (P = 0.009) and general anesthesia (P = 0.018); female patients had a higher level of anxiety about spinal surgery, and elderly patients had a higher level of anxiety about general anesthesia. The most helpful factors in overcoming anxiety before surgery and in reducing anxiety after surgery were faith in the medical staff (48.9 %) and surgeon's explanation of the surgery performed (72.3%), respectively. CONCLUSIONS Patients awaiting laminectomy or discectomy feared spinal surgery more than general anesthesia. This study also found that medical staff and surgeons play important roles in overcoming and reducing patient anxiety during the perioperative period.
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Affiliation(s)
- Jun-Seok Lee
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea
| | - Yong-Moon Park
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Wook Cho
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea
| | - Geun-Hyeong Bak
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea
| | - Ki-Won Kim
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea.
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Rabbitts JA, Groenewald CB, Tai GG, Palermo TM. Presurgical psychosocial predictors of acute postsurgical pain and quality of life in children undergoing major surgery. THE JOURNAL OF PAIN 2014; 16:226-34. [PMID: 25540939 DOI: 10.1016/j.jpain.2014.11.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/19/2014] [Accepted: 11/22/2014] [Indexed: 11/26/2022]
Abstract
UNLABELLED Limited research has examined presurgical risk factors for poor outcomes in children after major surgery. This longitudinal study examined presurgical psychosocial and behavioral factors as predictors of acute postsurgical pain intensity and health-related quality of life (HRQOL) in children 2 weeks after major surgery. Sixty children aged 10 to 18 years, 66.7% female, and their parent/guardian participated in the study. Children underwent baseline assessment of pain (daily electronic diary), HRQOL, sleep (actigraphy), and psychosocial factors (anxiety, pain catastrophizing). Caregivers reported on parental pain catastrophizing. Longitudinal follow-up assessment of pain and HRQOL was conducted at home 2 weeks after surgery. Regression analyses adjusting for baseline pain revealed that presurgery sleep duration (β = -.26, P < .05) and parental pain catastrophizing (β = .28, P < .05) were significantly associated with mean pain intensity reported by children 2 weeks after surgery, with shorter presurgery sleep duration and greater parental catastrophizing about child pain predicting greater pain intensity. Adjusting for baseline HRQOL, presurgery child state anxiety (β = -.29, P < .05) was significantly associated with HRQOL at 2 weeks, with greater anxiety predicting poorer HRQOL after surgery. In conclusion, child anxiety, parental pain catastrophizing, and sleep patterns are potentially modifiable factors that predict poor outcomes in children after major surgery. PERSPECTIVE This study addresses an important gap in literature, examining presurgical risk factors for poorer acute postsurgical outcomes in children undergoing major surgery. Knowledge of these factors will enable presurgical identification of children at risk for poorer outcomes and guide further research developing prevention and intervention strategies for these children.
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Affiliation(s)
- Jennifer A Rabbitts
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | | | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
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Liu Y, Hou B, Zhang W, Sun YE, Li L, Ma Z, Gu X. The activation of spinal astrocytes contributes to preoperative anxiety-induced persistent post-operative pain in a rat model of incisional pain. Eur J Pain 2014; 19:733-40. [PMID: 25257799 DOI: 10.1002/ejp.596] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Y. Liu
- Department of Anesthesiology; Affiliated Drum Tower Hospital of Medical School of Nanjing University; Jiangsu China
| | - B. Hou
- Department of Anesthesiology; Affiliated Drum Tower Hospital of Medical School of Nanjing University; Jiangsu China
| | - W. Zhang
- Department of Anesthesiology; Affiliated Drum Tower Hospital of Medical School of Nanjing University; Jiangsu China
| | - Y.-E. Sun
- Department of Anesthesiology; Affiliated Drum Tower Hospital of Medical School of Nanjing University; Jiangsu China
| | - L. Li
- Department of Anesthesiology; Affiliated Drum Tower Hospital of Medical School of Nanjing University; Jiangsu China
| | - Z. Ma
- Department of Anesthesiology; Affiliated Drum Tower Hospital of Medical School of Nanjing University; Jiangsu China
| | - X. Gu
- Department of Anesthesiology; Affiliated Drum Tower Hospital of Medical School of Nanjing University; Jiangsu China
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Brown NJ, Kimble RM, Rodger S, Ware RS, McWhinney BC, Ungerer JP, Cuttle L. Biological markers of stress in pediatric acute burn injury. Burns 2014; 40:887-95. [DOI: 10.1016/j.burns.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/26/2022]
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Britton WB, Lepp NE, Niles HF, Rocha T, Fisher NE, Gold JS. A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. J Sch Psychol 2014; 52:263-78. [PMID: 24930819 PMCID: PMC4060047 DOI: 10.1016/j.jsp.2014.03.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/30/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
The current study is a pilot trial to examine the effects of a nonelective, classroom-based, teacher-implemented, mindfulness meditation intervention on standard clinical measures of mental health and affect in middle school children. A total of 101 healthy sixth-grade students (55 boys, 46 girls) were randomized to either an Asian history course with daily mindfulness meditation practice (intervention group) or an African history course with a matched experiential activity (active control group). Self-reported measures included the Youth Self Report (YSR), a modified Spielberger State-Trait Anxiety Inventory, and the Cognitive and Affective Mindfulness Measure -Revised. Both groups decreased significantly on clinical syndrome subscales and affect but did not differ in the extent of their improvements. Meditators were significantly less likely to develop suicidal ideation or thoughts of self-harm than controls. These results suggest that mindfulness training may yield both unique and non-specific benefits that are shared by other novel activities.
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Affiliation(s)
- Willoughby B Britton
- Brown University Contemplative Studies Initiative, USA; Department of Psychiatry and Human Behavior, Brown University Medical School, USA.
| | | | - Halsey F Niles
- Brown University Contemplative Studies Initiative, USA; Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, USA
| | - Tomas Rocha
- Brown University Contemplative Studies Initiative, USA; Mind & Life Institute, USA
| | - Nathan E Fisher
- Brown University Contemplative Studies Initiative, USA; Department of Psychiatry and Human Behavior, Brown University Medical School, USA
| | - Jonathan S Gold
- Brown University Contemplative Studies Initiative, USA; Moses Brown School, USA
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71
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Beringer RM, Segar P, Pearson A, Greamspet M, Kilpatrick N. Observational study of perioperative behavior changes in children having teeth extracted under general anesthesia. Paediatr Anaesth 2014; 24:499-504. [PMID: 24491117 DOI: 10.1111/pan.12362] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perioperative behavioral disturbance is common in children. Negative behavior changes may be seen during induction of anesthesia, during recovery and following discharge home. There has been little research on this subject in the UK. OBJECTIVES The aim of this study was to determine the incidence of behavioral changes within our institution and identify which children are at increased risk. METHODS A prospective observational study of healthy children aged two to 12 undergoing elective dental extractions under general anesthesia. Assessments included: the child's and parent's state anxiety; anxiety and behavior during induction of anesthesia (modified Yale preoperative anxiety scale and the pediatric anesthesia behavior score); behavior in PACU (pediatric anesthesia emergence delirium [PAED] scale); behavior at home on postoperative days 1 and 7 (post hospitalization behavior questionnaire). Data were examined for associations and correlations. RESULTS One hundred and two children with a median age of 6 years were recruited. Sixty-seven per cent exhibited high anxiety during induction of anesthesia, although only 3% demonstrated significant vocal or physical resistance. Thirteen per cent had a PAED score of 10 or more. Post-hospitalization behavior changes were demonstrated by 52% of children on day 1 and 22% on day 7; and were associated with: a previous traumatic healthcare experience, male sex, and distress during induction of anesthesia. CONCLUSIONS Perioperative behavioral disturbance is common in children undergoing anesthesia. Predicting which children are at increased risk may allow us to adapt the management of these children in order to minimize adverse behavior changes.
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Affiliation(s)
- Richard M Beringer
- Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
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The facial affective scale as a predictor for pain unpleasantness when children undergo immunizations. Nurs Res Pract 2014; 2014:628198. [PMID: 24734174 PMCID: PMC3964891 DOI: 10.1155/2014/628198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/16/2014] [Accepted: 01/30/2014] [Indexed: 12/12/2022] Open
Abstract
Needle fear is a common problem in children undergoing immunization. To ensure that the individual child's needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions.
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73
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Cheseaux N, de Saint Lager AJ, Walder B. Hypnosis before diagnostic or therapeutic medical procedures: a systematic review. Int J Clin Exp Hypn 2014; 62:399-424. [PMID: 25084616 DOI: 10.1080/00207144.2014.931170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this systematic review was to estimate the efficiency of hypnosis prior to medical procedures. Different databases were analyzed to identify randomized controlled trials (RCTs) comparing hypnosis to control interventions. All RCTs had to report pain or anxiety. Eighteen RCTs with a total of 968 patients were included; study size was from 20 to 200 patients (14 RCTs ≤ 60 patients). Fourteen RCTs included 830 adults and 4 RCTs included 138 children. Twelve of 18 RCTs had major quality limitations related to unclear allocation concealments, provider's experience in hypnosis, patient's adherence to hypnotic procedures, and intention-to-treat design. This systematic review observed major methodological limitations in RCTs on hypnosis prior to medical procedures.
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Liu CY, Xu L, Zang YL. Effectiveness of audiovisual interventions on stress responses in adolescents with ENT surgery in hospital: randomized controlled trial protocol. J Adv Nurs 2013; 70:1414-24. [PMID: 24206233 DOI: 10.1111/jan.12295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/30/2022]
Abstract
AIM To investigate the circadian pattern of cortisol secretion and other stress indictors in association with audiovisual stimuli in adolescents having otorhinolaryngological surgery in hospital. BACKGROUND Hospitalization for surgery is a major stressful life event for adolescents causing negative consequences, including anxiety. Recent studies suggest that entertaining and educational interventions might be effective at reducing such adversities, but little is known about the pattern of these responses and effects. DESIGN Randomized controlled trial. METHODS Adolescents with otorhinolaryngological surgery in hospital without any contraindictions for salivary cortisol enzyme immunoassays will be recruited and randomly allocated to experimental, placebo and control. Stress indicators will be collected regularly for 5 days. Standard audiovisual interventions will be displayed for experimental and placebo groups including a simultaneous video-recording of facial and behavioural changes on the second afternoon postadmission and stress indicators will be collected pre- and three times with 20-minute interval postintervention. Follow-up will be conducted to evaluate the longer term effects at 2 weeks, 1-month and 3 months postadmission, respectively. Descriptive and comparative analyses of stress indicators will be performed to examine group differences. Competitive funding was obtained from the Independent Innovation Foundation of Shandong University for interdisciplinary research in 2012. DISCUSSION This study will help identify timeslots for interventions for integrating strength-building into stress response reduction in adolescents hospitalized for surgery.
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Affiliation(s)
- Cai Yun Liu
- School of Nursing, Shandong University, Jinan, China; ENT Unit, Shandong Provincial Hospital (West Branch), Jinan, China
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75
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Salgado Filho MF, Gonçalves HB, Pimentel Filho LH, Rodrigues DDS, da Silva IP, Avarese de Figueiredo A, Bastos Netto JM. Assessment of pain and hemodynamic response in older children undergoing circumcision: comparison of eutectic lidocaine/prilocaine cream and dorsal penile nerve block. J Pediatr Urol 2013; 9:638-42. [PMID: 22897985 DOI: 10.1016/j.jpurol.2012.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/13/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate whether dorsal penile nerve block (DPNB) or local topical anesthesia (LT) provided better postoperative analgesia and less hemodynamic stimulation during and after circumcision surgery with Plastibell in older children. METHODS Forty-one subjects (age: 2-13 years) undergoing circumcision with Plastibell were randomly divided into LT and DPNB groups. Inhalation induction was performed with an 8% end-tidal sevoflurane concentration. In the LT group, a eutectic ointment of 5% lidocaine and 5% prilocaine was applied to the foreskin 1 h before surgery. At 10 min after anesthesia induction, the end-tidal sevoflurane concentration was decreased to 2%. In the other group, a DPNB was performed with 0.5% bupivacaine (1 mg/kg). Heart rate (HR), respiratory rate, mean arterial pressure (MAP), and involuntary movements were evaluated at anesthesia induction (T0), 1 min after DPNB (T1), 1 min after incision (T2), and 1 min after surgery (T3). Pain was evaluated at 1 and 24 h after surgery, and complications were evaluated at 24 h after surgery. RESULTS The groups were homogeneous with respect to age, weight, glans diameter, penile length, Kayaba classification, and surgical duration. The LT group showed increased HR (p = 0.073) and MAP (p = 0.046) at T2 as compared to T0. No hemodynamic changes were observed in the HPDB group. The LT group showed a higher pain score at 1 h after surgery than the DPNB group, whereas the DPNB group had a higher incidence of hematoma (p = 0.02) at 24 h after surgery. CONCLUSION Anesthesia with 5% lidocaine and 5% prilocaine cream during circumcision of older children with Plastibell under general anesthesia with sevoflurane does not provide satisfactory perioperative hemodynamic stability or postoperative analgesia.
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Sadhasivam S, Chidambaran V. Pharmacogenomics of opioids and perioperative pain management. Pharmacogenomics 2013; 13:1719-40. [PMID: 23171337 DOI: 10.2217/pgs.12.152] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Inadequate pain relief and adverse effects from analgesics remain common in children and adults during the perioperative period. Opioids are the most commonly used analgesics in children and adults to treat perioperative pain. Narrow therapeutic index and a large interpatient variability in response to opioids are clinically significant, with inadequate pain relief at one end of the spectrum and serious side effects, such as respiratory depression and excessive sedation due to relative overdosing, at the other end. Personalizing analgesia during the perioperative period attempts to maximize pain relief while minimizing adverse events from therapy. While various factors influence response to treatment among surgical patients, age, sex, race and pharmacogenetic differences appear to play major roles in predicting outcome. Genetic factors include a subset of genes that modulate the proteins involved in pain perception, pain pathway, analgesic metabolism (pharmacokinetics), transport and receptor signaling (pharmacodynamics). While results from adult genetic studies can provide direction for pediatric studies, they have limited direct applicability, as children's genetic predispositions to analgesic response may be influenced by developmental and behavioral components, altered sensitivity to analgesics and variation in gene-expression patterns. We have reviewed the available evidence on improving and personalizing pain management with opioids and the significance of individualizing analgesia, in order to maximize analgesic effect with minimal adverse effects with opioids. While the early evidence on individual genotype associations with pain, analgesia and opioid adverse outcome are promising, the large amount of conflicting data in the literature suggests that there is a need for larger and more robust studies with appropriate population stratification and consideration of nongenetic and other genetic risk factors. Although the clinical evidence and the prospect of being able to provide point-of-care genotyping to enable clinicians to deliver personalized analgesia for individual patients is still not available, positioning our research to identify all possible major genetic and nongenetic risk factors of an individual patient, advancing less expensive point-of-care genotyping technology and developing easy-to-use personalized clinical decision algorithms will help us to improve current clinical and economic outcomes associated with pain and opioid pain management.
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Affiliation(s)
- Senthilkumar Sadhasivam
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.
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Chieng YJS, Chan WCS, Klainin-Yobas P, He HG. Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: a quantitative systematic review. J Adv Nurs 2013; 70:243-55. [PMID: 23865442 DOI: 10.1111/jan.12205] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2013] [Indexed: 11/30/2022]
Abstract
AIMS To examine the relationship between perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures and the differences in children's perioperative anxiety and postoperative pain among subgroups of demographics. BACKGROUND While anxiety and pain are regarded as two common problems experienced by children and adolescents perioperatively and the relationship between them has been reported in previous studies, there has been no review paper examining this phenomenon. DESIGN A quantitative systematic review. DATA SOURCES Nine electronic databases were searched for studies published in English from the inception date of the databases to December 2010, using various combinations of search terms of 'adolescents', 'anxiety', 'child', 'pain', 'surgery' and 'correlation/relationship'. REVIEW METHODS Using the Joanna Briggs Institute's comprehensive systematic review strategies, relevant studies were independently appraised and extracted by two reviewers using the standardized critical appraisal instruments and data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. RESULTS Ten studies were included in this review from 943 studies initially retrieved. Children and adolescents who had higher level of perioperative anxiety experienced a higher level of postoperative pain. Inconclusive evidence was found regarding differences of perioperative anxiety and postoperative pain between demographic subgroups of gender, age and past surgical experience. CONCLUSION Results of this review inform healthcare providers of the role perioperative anxiety plays on children's and adolescents' postoperative pain and indicate the need to use interventions to reduce perioperative anxiety and, therefore, optimize their postoperative pain management during the perioperative period.
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Chieng YJS, Chan WCS, Liam JLW, Klainin-Yobas P, Wang W, He HG. Exploring influencing factors of postoperative pain in school-age children undergoing elective surgery. J SPEC PEDIATR NURS 2013; 18:243-52. [PMID: 23822848 DOI: 10.1111/jspn.12030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to examine the influencing factors of postoperative pain among children undergoing elective surgery. DESIGN AND METHODS A survey was conducted in 2011 with a convenience sample of 66 children, 6 to 14 years old, in a tertiary hospital in Singapore. RESULTS Children experienced moderate preoperative anxiety and postoperative pain. Gender, preoperative anxiety, and negative emotional behaviors were significant influencing factors for postoperative pain. Boys reported less postoperative pain than girls. PRACTICE IMPLICATIONS Effective strategies for assessing and managing children's preoperative anxiety are needed to achieve an optimal postoperative pain management outcome.
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Rabarin F, Cesari B, Jeudy J, Saint Cast Y, Fouque PA, Raimbeau G. [Cartoons, local anesthesia and nitrous oxide: a solution for the treatment of child's hands wounds]. CHIRURGIE DE LA MAIN 2013; 32:63-67. [PMID: 23490216 DOI: 10.1016/j.main.2013.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 11/21/2012] [Accepted: 02/07/2013] [Indexed: 06/01/2023]
Abstract
Wounds and injuries of child's hands are common and create anxiety. The context of stress makes difficult therapeutic cares, anesthesia and surgery, and prevents child's cooperation. We propose a technique combining a local anesthesia performed during inhalation of oxygen and nitrous oxide, and child distraction by watching a cartoon. In a prospective series of 39 children, we evaluated the feasibility of such care and its impact on the child's anxiety by a visual analog scale (VAS) at three moments of care sequence: arrival of the child (EVA1), at the end of the cartoon (EVA2), and at the postoperative visit (EVA3). Thirty-seven children were included (94.9%). Mean anxiety decreased throughout the therapeutic course: EVA1 (5.6), EVA2 (2.97), EVA3 (1.4). Children were less and less anxious along the procedure (100%, 46%, 10.8%, respectively). All children could be treated as outpatients. This procedure allows a rapid and adapted treatment for children's hand injuries. It reduces impact of children's anxiety.
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Affiliation(s)
- F Rabarin
- Centre de la main, Angers assistance main, 47, rue de la Foucaudière, 49800 Trelaze, France.
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80
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Bataille B, Mora M, Blasquez S, Moussot PE, Silva S, Cocquet P. [Training to management of violence in hospital setting]. ACTA ACUST UNITED AC 2013; 32:165-9. [PMID: 23474002 DOI: 10.1016/j.annfar.2012.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/10/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evaluate the typology of violence in hospital setting, study the psychophysiological state of care givers dealing with the aggression and provide appropriate training. STUDY DESIGN Single centre, observational. PATIENTS AND METHODS A first anonymous questionnaire was given to a sample of emergency and intensive care providers in Narbonne Hospital. The parameters studied included: demographics data, the Trait Anxiety Inventory test, the typology of aggressions, and the psycho-physiological state of subjects dealing with the aggression. Robert Paturel, an instructor of French Special Forces (Recherche-Assistance-Intervention-Dissuasion [RAID]), has provided training for the management of violence. A second questionnaire assessed satisfaction for proposed formation. RESULTS Forty-one questionnaires were returned. The rates of verbal and physical violence touching care givers were respectively 97 % and 41 % (median of 7years [1-36] experience on the job). Eighty-five percent of care givers wanted training in psychology of conflict and 93 % wanted a formation with a self-defense aspect. The first reason of violence was drugs and alcohol abuse. The "tunnel effect" during stress was identified in 34 % of care givers, and 20 % were unaware of its nature. Twenty-one percent of care givers spontaneously adopting a safe distance of more than 1m during a conflict had been physically assaulted versus 63 % for those staying less than 1m (P=0.03). The proposed formation, including psychology of conflict and self-defense, was satisfactory to all care givers who participated (median score 9/10 [7-10]). CONCLUSION The verbal and physical violence affecting emergency departments is a common phenomenon warranting appropriate training. The proposed formation included the comprehension of the conflict causality, self-defense and self-control.
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Affiliation(s)
- B Bataille
- Pôle urgence-réanimation-Smur, centre hospitalier de Narbonne, boulevard Dr-Lacroix, 11100 Narbonne, France.
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81
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A randomized, controlled trial to evaluate topical anesthetic for 15 minutes before venipuncture in pediatrics. Am J Emerg Med 2013; 31:20-5. [DOI: 10.1016/j.ajem.2012.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/02/2012] [Accepted: 05/02/2012] [Indexed: 11/18/2022] Open
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82
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Treviño RP, Pham TH, Edelstein SL. Obesity and preference-weighted quality of life of ethnically diverse middle school children: the HEALTHY study. J Obes 2013; 2013:206074. [PMID: 23853717 PMCID: PMC3703726 DOI: 10.1155/2013/206074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/17/2013] [Indexed: 01/01/2023] Open
Abstract
To date, studies examining the relation between body mass index percentile (BMI%) categories and health-related quality of life (QOL) measurements have not reported preference-weighted scores among ethnically diverse children. We report the associations between BMI% categories and preference-weighted scores among a large cohort of ethnically diverse sixth grade children who participated in the HEALTHY school-based type 2 diabetes risk factor prevention study. Health Utility Index 2 (HUI2) and Health Utility Index 3 (HUI3) and the feeling thermometer (FT) were the preference-weighted QOL instruments used to measure student's preference scores. Of 6358 consented students, 4979 (78.3%) had complete QOL, height, weight, and covariate data. Mean (SD) preference scores were 0.846 (0.160), 0.796 (0.237), and 0.806 (0.161) for the HUI2, HUI3, and FT, respectively. After adjusting for age, sex, blood glucose and insulin, Tanner stage, race/ethnicity, family history of diabetes, and educational attainment, children with severe obesity (>99%) had significantly lower preference scores compared to normal weight on all three instruments (HUI2 P = 0.013; HUI3 P = 0.025; and FT P < 0.001). Obese and severe obese categories were significantly associated with lower HUI2 functional ratings in the mobility domain and with lower HUI3 functional ratings in the speech domain.
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Affiliation(s)
- R P Treviño
- Social and Health Research Center, San Antonio, TX 78210, USA.
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83
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Brown NJ, Rodger S, Ware RS, Kimble RM, Cuttle L. Efficacy of a children's procedural preparation and distraction device on healing in acute burn wound care procedures: study protocol for a randomized controlled trial. Trials 2012; 13:238. [PMID: 23234491 PMCID: PMC3543349 DOI: 10.1186/1745-6215-13-238] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 11/27/2012] [Indexed: 11/17/2022] Open
Abstract
Background The intense pain and anxiety triggered by burns and their associated wound care procedures are well established in the literature. Non-pharmacological intervention is a critical component of total pain management protocols and is used as an adjunct to pharmacological analgesia. An example is virtual reality, which has been used effectively to dampen pain intensity and unpleasantness. Possible links or causal relationships between pain/anxiety/stress and burn wound healing have previously not been investigated. The purpose of this study is to investigate these relationships, specifically by determining if a newly developed multi-modal procedural preparation and distraction device (Ditto™) used during acute burn wound care procedures will reduce the pain and anxiety of a child and increase the rate of re-epithelialization. Methods/design Children (4 to 12 years) with acute burn injuries presenting for their first dressing change will be randomly assigned to either the (1) Control group (standard distraction) or (2) Ditto™ intervention group (receiving Ditto™, procedural preparation and Ditto™ distraction). It is intended that a minimum of 29 participants will be recruited for each treatment group. Repeated measures of pain intensity, anxiety, stress and healing will be taken at every dressing change until complete wound re-epithelialization. Further data collection will aid in determining patient satisfaction and cost effectiveness of the Ditto™ intervention, as well as its effect on speed of wound re-epithelialization. Discussion Results of this study will provide data on whether the disease process can be altered by reducing stress, pain and anxiety in the context of acute burn wounds. Trial registration ACTRN12611000913976
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Affiliation(s)
- Nadia J Brown
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Royal Children's Hospital, Brisbane, Queensland, Australia.
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84
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Assessing Children's Anxiety Using the Modified Short State-Trait Anxiety Inventory and Talking Mats: A Pilot Study. Nurs Res Pract 2012; 2012:932570. [PMID: 22991660 PMCID: PMC3444045 DOI: 10.1155/2012/932570] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 07/29/2012] [Accepted: 08/03/2012] [Indexed: 02/07/2023] Open
Abstract
Background. Preoperative anxiety complicates treatment and requires assessment by nurses in children. Children, with or without disability, are helped when pictures are used to support communication. The purpose of this pilot study was to test the reliability and validity of the modified short State-Trait Anxiety Inventory (STAI) using a modified Talking Mats method in children undergoing day surgeries. Method. A modified short STAI with pictorial support along the lines of the Talking Mats method was pre- and postoperatively administered to 42 typically developing children aged three to nine years. The parents assessed the children's anxiety, simultaneously and independently, by scoring the short STAI by proxy. Results. The modified short STAI showed moderate internal consistency and good construct validity in the age group seven to nine years. Conclusions. The results of this study support the use of the instrument for self-reports in children aged seven to nine years. Future research will explore the possibilities of also using this instrument for children with cognitive and communicative difficulties.
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85
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Ortiz MI, López-Zarco M, Arreola-Bautista EJ. Procedural pain and anxiety in paediatric patients in a Mexican emergency department. J Adv Nurs 2012; 68:2700-9. [PMID: 22381114 DOI: 10.1111/j.1365-2648.2012.05969.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM This article is a report of a study carried out to investigate the procedures that are likely to induce pain and anxiety in children in a Mexican emergency department. BACKGROUND In emergency rooms, children often experience unpredictable diagnostic and therapeutic procedural-related pain that can be associated with considerable anxiety. DESIGN A prospective, descriptive and cross sectional study was conducted to investigate the prevalence of procedures or situations that probably induced anxiety and/or pain in children in an emergency room. METHODS Procedural pain and anxiety were evaluated in children and adolescents (8-16 years) who were admitted to the emergency department of a paediatric hospital between February-September 2010. Children rated their pain and anxiety using a 100-mm visual analogue scale. RESULTS A total of 252 children with a mean age of 10·1 years were evaluated. Four-hundred fifty-nine procedures were completed, with an average of 1·82 events/child. Of these procedures, 369 (80·4%) were rated painful and 357 (77·8%) were rated stressful. The most frequently reported procedural pain or stressful episodes were peripheral catheterization, clinical examination and vascular puncture. Overall, 32·5% of the painful events were rated severe, 32·0% were rated moderate and 35·5% were rated slight. However, 30% of the stressful events were rated severe, 38·9% were rated moderate and 31·1% were rated slight. Peripheral catheterization was rated severe in 58 children (33·9%), moderate in 55 children (32·2%) and slight in 58 (33·9%) children. CONCLUSION This study provides data on common emergency department procedures that cause pain and anxiety in children and young adolescents. Healthcare providers must consider the best psychological and pharmacological interventions to reduce procedural anxiety and pain.
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Affiliation(s)
- Mario I Ortiz
- Área Académica de Medicina del Instituto de Ciencias de la Salud de la Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico.
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Noel M, Chambers CT, McGrath PJ, Klein RM, Stewart SH. The Role of State Anxiety in Children's Memories for Pain. J Pediatr Psychol 2012; 37:567-79. [DOI: 10.1093/jpepsy/jss006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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87
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Soliveres J, Sánchez A, Balaguer J, Estruch M, Sánchez J, Solaz C. [Parental presence in the operating room: effect on the quality of anesthetic induction and postoperative agitation in children]. ACTA ACUST UNITED AC 2012; 58:472-6. [PMID: 22141214 DOI: 10.1016/s0034-9356(11)70121-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Various nonpharmacologic strategies for reducing anxiety in children and improving cooperation during induction of anesthesia have been investigated. Parental presence during anesthetic induction has been the alternative studied most often, especially in English-speaking populations. Mixed results have been reported, however. The aim of this study was to evaluate the quality of anesthetic induction and the development of postoperative agitation in Spanish children undergoing ear, nose, or throat surgery with or without parental presence in the operating room. PATIENTS AND METHODS Children in American Society of Anesthesiologists class 1 or 2 who were scheduled for ear, nose or throat surgery under inhalation anesthesia were randomized to 2 groups for presence or absence of a parent in the operating room. The induction experience was classified as easy, carried out with moderate resistance, or traumatic. The postoperative period was assessed as easy or traumatic. RESULTS Forty children were randomized. Time to onset of anesthesia was similar in the 2 groups. Induction was easy for 65% of the children with parental presence and for 25% of the children without a parent present (P < .05). Induction was traumatic for 25% in the parental presence group and for 35% in the parental absence group (P < .05). The incidence of moderate resistance during induction was similar in the 2 groups; the quality of the postoperative experience was also similar. CONCLUSIONS Parental presence during induction of inhalation anesthesia improves the induction experience of nonpremeditated Spanish children, increasing the incidence of easy induction and decreasing the presence of traumatic induction. The quality of the postoperative experience is similar.
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Affiliation(s)
- J Soliveres
- Servicio de Anestesiología y Reanimación, Hospital Universitario Doctor Peset, Valencia.
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88
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Foster RL, Park JH. An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children. Pain Manag Nurs 2011; 13:94-106. [PMID: 22652282 DOI: 10.1016/j.pmn.2011.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 06/22/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022]
Abstract
Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.
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Affiliation(s)
- Roxie L Foster
- University of Colorado Denver College of Nursing, Aurora, Colorado, USA
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89
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Abstract
PURPOSE OF REVIEW Distress in children during hospitalization is increasingly seen as unacceptable and preventable. Surgery and anaesthesia are distressing events for children with maximum stress at induction of anaesthesia. This review aims to report the recent research relevant to reducing this distress in children with a focus on the preoperative period and the impact of this on behaviour at induction and long-term postoperatively. RECENT FINDINGS The development of new measures of anxiety in children, which are specifically designed to measure anxiety in the perioperative period has allowed better assessment of the efficacy of interventions. Studies continue to demonstrate that a variety of nonpharmacological interventions have a modest effect in reducing anxiety and that sedative premedication is more effective. Clinical indications for preoperative sedative/anxiolytic medication across institutions are very variable. Clonidine and dexmedetomidine (α2-adrenergic agonists) produce satisfactory sedation in children but have long onset times. Recent focus on the importance of minimizing children's distress in clinical areas outside the operating suite is creating pressure on anaesthetists to reassess what is considered 'acceptable' in relation to distress at induction of anaesthesia. The ChildKind Initiative summarizes pain minimization strategies, which should be applied to children. It is logical to extend this concept to minimization of distress unrelated to pain. SUMMARY New measures of anxiety will facilitate better evaluation of children clinically and better future research. The role of α2-adrenergic agonists in premedication remains unclear. There is still little research, which examines outcomes for techniques for minimizing distress, which are based on specific assessment of the child and family.
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Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Even though the regulatory authorities to some extent accept the extrapolation of efficacy data from adults to paediatric patients, it is often the case that differences in the disease process and the developmental stage of the children prevent the extrapolation of efficacy in these populations. Where efficacy studies are needed, the development, validation, and employment of different endpoints for specific age and developmental subgroups become necessary. Children are in continuous development and any measure to assess the efficacy of an intervention should take carefully into account how this development affects the endpoints, including the performance capacity of the child and differences in the condition and symptoms presented. Clinical endpoints that are used in the adult trials to evaluate treatment effect may not be suitable in paediatric studies. The development of surrogate endpoints for benefit and risk assessment in children is necessary. Collaboration between the academic researchers, pharmaceutical industry, and regulatory authorities is needed to meet the challenges in proper validation of biomarkers and surrogate endpoints in paediatric trials.
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Affiliation(s)
- Siri Wang
- Norwegian Medicines Agency, Tønsberg Hospital Pharmacy, Sven Oftedalsvei 6, N-0950 Oslo, Norway.
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Current world literature. Neuroanaesthesia. Pain medicine. Regional anaesthesia. Curr Opin Anaesthesiol 2010; 23:671-8. [PMID: 20811177 DOI: 10.1097/aco.0b013e32833f3f68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Messerer B, Gutmann A, Weinberg A, Sandner-Kiesling A. Implementation of a standardized pain management in a pediatric surgery unit. Pediatr Surg Int 2010; 26:879-89. [PMID: 20625751 DOI: 10.1007/s00383-010-2642-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2010] [Indexed: 12/20/2022]
Abstract
Postoperative pain is still a major complication causing discomfort and significant suffering, especially for children. Therefore, every effort should be made to prevent pain and treat it effectively once it arises. Under-treatment of pediatric pain is often due to a lack of both knowledge about age-specific aspects of physiology and pharmacology and routine pain assessment. Factors for long term success require regularly assessing pain, as routinely as the other vital signs together with documentation of side effects. The fear of side effects mostly prevents the adequate usage of analgesics. Essential is selecting and establishing a simple concept for clinical routine involving a combination of non-pharmacological treatment strategies, non-opioid drugs, opioids and regional anesthesia.
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Affiliation(s)
- B Messerer
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
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94
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Abstract
UNLABELLED OBJECTIVES & AIM: The purpose of this investigation was to examine children's anxiety across the perioperative setting. BACKGROUND Although several studies have examined preoperative anxiety in children, few researchers have illustrated perioperative anxiety; that is, anxiety in children throughout the pre and postoperative continuum. METHODS Participants were 261 children ages 2-12. Anxiety was rated prior to surgery, immediately after surgery, and for 2 weeks at home following surgery. RESULTS Low child sociability and high parent anxiety predicted perioperative anxiety. Perioperative anxiety was related to postoperative pain and negative postoperative behavioral change. CONCLUSIONS Identification and prevention of anxiety in children can help prevent negative outcomes following surgery.
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Affiliation(s)
- Michelle A Fortier
- Department of Anesthesiology and Perioperative Care, University of California-Irvine, Orange, CA, USA.
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