Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

[Pain and postoperative behavioural changes following adenoidectomy and ear tube placement in children]

OBJECTIVES

The purpose of this study was to evaluate postoperative pain in the hospital and at home as well as behavioural changes at home following outpatient adenoidectomy (VG) and ear tube (ATT) surgery.

STUDY DESIGN

Prospective cohort study.

PATIENTS AND METHODS

Sixty-four children (mean age 4.3+/-2.4 years): 28 VG, 16 (ATT), 20 dual surgeries (VG-ATT). Postoperative pain was evaluated (arrival in recovery room, departure from wake-up room, departure from hospital) using the Objective Pain Scale (OPS). Parents evaluated their child's pain at home over a period of seven days using a numeric pain scale. Behavioural changes were measured with the Post-Hospital Behaviour Questionnaire (PHBQ).

RESULTS

At arrival in the recovery room, OPS=3.5 [0-6]. A statistically significant difference (p<0.05) was shown between the VG group (OPS=5 [2.25-7.75]), and the ATT (OPS=0 [0-5.5]) and VG-ATT (OPS=2 [0-5.75]) groups. OPS was 1.0 [0-2] when leaving the recovery room, and OPS was 0 [0-1] when leaving the hospital. Numeric pain scale scores recorded at home were extremely low. Postoperatively, 75% of parents at Day 1 and 40.6% at Day 7 reported at least one postoperative behavioural change.

DISCUSSION

In all three groups, parents reported frequent postoperative behaviour changes despite adequate analgesia.

CONCLUSION

The relatively high frequency of postoperative behaviour changes in this population demonstrates the need to systematically evaluate those changes in order to improve overall paediatric care.

Managing childhood fever and pain--the comfort loop

Parents can transmit their anxiety to their child, and just as children can pick up on parental anxiety, they can also respond to a parent's ability to stay calm in stressful situations. Therefore, when treating children, it is important to address parental anxiety and to improve their understanding of their child's ailment. Parental understanding and management of both pain and fever - common occurrences in childhood - is of utmost importance, not just in terms of children's health and welfare, but also in terms of reducing the economic burden of unnecessary visits to paediatric emergency departments. Allaying parental anxiety reduces the child's anxiety and creates a positive feedback loop, which ultimately affects both the child and parentIn this review, the integral role of parental perception of the child's condition and the efficacy of treatment in the management of childhood fever and pain will be discussed.

The pediatric cardiac patient presenting for noncardiac surgery

PURPOSE OF REVIEW

To summarize results of recent papers and discuss current trends concerning anesthesia in children with congenital heart disease presenting for noncardiac surgery.

RECENT FINDINGS

Children with congenital heart disease have a significant incremental risk when presenting for minor or major surgery. It is a current trend that noncardiac surgery should be performed in pediatric centers, which have anesthesiologists and pediatricians familiar with the multiple specialties of children with congenital heart disease. A careful preoperative evaluation using a multidisciplinary approach is of great importance. In recent studies and case reports, the safe use of newer anesthetic agents, such as sevoflurane or desflurane, was reported in combination with opioids or regional blocks. In addition to standard monitors, invasive monitoring should be considered liberally perioperatively in patients with limited hemodynamic reserve and with major surgery. Several case reports reported that laparoscopic surgery was successfully performed even in high-risk patients with congenital heart disease.

SUMMARY

Careful preoperative evaluation, experienced anesthesiologists, suitable anesthetic agents and techniques, and the liberal use of invasive monitoring are integral parts of safe and effective anesthetic care in children with congenital heart disease. Future studies have to show whether laparoscopic surgery may be beneficial in this special subgroup of patients.

Risk factor research and prevention for anxiety disorders: introduction to the special series on risk and prevention of anxiety pathology

In relation to treatment-related research in the United States, there is relatively little systematic effort focused on the combination of risk and prevention for anxiety pathology. This article broadly discusses risk factor research and prevention program development for anxiety psychopathology. The authors also specifically discuss papers in this special issue that are focused on these topics. Risk factor research should be used by clinical researchers to inform prevention programs, and reciprocally, prevention knowledge should be effectively utilized to drive new, clinically focused risk factor research.