[Uncooperative children during induction of anesthesia : theory and practice]

Effectiveness of two distraction strategies in reducing preoperative anxiety in children in China: A randomized controlled trial

PURPOSE

Music and animation are the most common and affordable distraction strategies to reduce preoperative anxiety in children; however, their effects are inconsistent. This study aimed to examine the effectiveness of two distraction strategies (music or animation) in reducing preoperative anxiety in children.

DESIGN AND METHODS

In this randomized controlled trial, 183 children who underwent surgery were divided into music, animation, and control groups using a single-blind block randomized design. Children in the control group underwent routine preoperative visits. Meanwhile, the children in the intervention groups could choose their favorite music and cartoons as intervention content. Study outcomes included anxiety levels, degree of cooperation, heart rate, and blood pressure. Data were collected before entering the operating room, entering the operating room, and before the induction of anesthesia; only the degree of cooperation was collected before the induction of anesthesia.

RESULTS

Only animation significantly reduced preoperative anxiety in the children (P < 0.05) upon entering the operating room. Both music and animation reduced the level of preoperative anxiety before induction of anesthesia; however, there was no significant difference between them (P > 0.05). The induction compliance score was significantly lower in the music and animation groups than in the control group (P < 0.05). Heart rates differed significantly between the three groups from before entering the operating room to before induction of anesthesia. Children in the control group had the highest systolic blood pressure upon entering the operating room (P < 0.05).

CONCLUSIONS

Music and animation strategies can significantly reduce preoperative anxiety in children and improve surgical cooperation during anesthesia induction.

TRIAL REGISTRATION

Clinical.

TRIALS

gov NCT05285995.

[Drugs for intravenous induction of anesthesia: ketamine, midazolam and synopsis of current hypnotics]

Ketamine and midazolam form the endpoint of a series of articles about intravenous induction of anesthesia . Both substances can be used as single induction hypnotic drugs; however, in practice, this is unusual. Both substances, with the exception of a few very specific indications and clinical situations, are more frequently used in combination or with one of the more common alternatives propofol, barbiturates and etomidate. The reasons are the activity and side effects of both substances and their positive characteristics are used more as a supplement. In the concluding comparison the five discussed induction hypnotics are judged against each other. The use in certain clinical constellations and in special patient populations is evaluated individually for each substance. It is highlighted which drug appears most appropriate in which situation. As methohexital is nowadays only administered in very few clinical situations, this substance is not included in the comparative assessment.

[Pediatric outpatient surgery]

BACKGROUND

The number of outpatient surgeries for routine surgical interventions continues to increase, especially in adults. For many patients, there is no doubt that interventions like arthroscopy will be performed on an outpatient basis. Regarding urologic surgeries in adults (e.g., vasectomy, hydrecelectomy), outpatient treatment is well established. For adults such a procedure represents a well-calculable situation in most cases, as the patient can quite accurately imagine the events that will follow. In terms of pediatric outpatient surgery, the scenario is sometimes quite different. Parents are more anxious and uncertain because they must decide for the well-being of their children and they often do not exactly know what will happen during the procedure. In addition, they do not have to decide for themselves but for their children.

DISCUSSION

Unfortunately, parents often lack information prior to surgery. Therefore, all persons involved in the treatment of children (e.g., urologists, anesthesiologists, nurses) must be trained and educated in giving adequate and appropriate information especially for parents.

CONCLUSION

The purpose of this article is to provide different starting points for an optimized preparation and care of children and parents concerning outpatient surgery in pediatric urology.

An evaluation of the effectiveness and safety of midazolam in children undergoing dental surgery

OBJECTIVE

The aim of this study was to evaluate the effectiveness and safety of oral midazolam in children undergoing dental surgery.

MATERIALS AND METHODS

A prospective, randomized, controlled trial was conducted to assess the effectiveness and safety of midazolam in children. Patients aged 2-9 years who underwent dental surgery under general anesthesia were randomly allocated into one of the four groups: midazolam 0.2mg/kg dose group (n=30); midazolam 0.21-0.4mg/kg dose group (n=15); midazolam more than 0.41mg/kg dose group (n=15) or the placebo group (n=31). The effectiveness of midazolam on sedation was assessed by the evaluation of vital signs, such as the respiratory and heart rate, oxygen saturation and the patients' reactive behaviors, in comparison with the placebo.

RESULTS

The scores of the ratings for sleep, movement and crying, as well as patients' reactions at the moment of separation from their parents and their collaboration with the staff were statistically significantly better among patients who received oral midazolam compared with the placebo. There were statistically significant direct correlations between the doses of midazolam and higher sleep, movement, crying and reaction scores 30min after premedication as well as higher scores of patients upon separation from their parents. There were only a few clinically insignificant side effects.

CONCLUSIONS

Oral midazolam, at a single dose from 0.2 to 0.6mg/kg, is effective and safe, and provides the expected sedative effects in children required by premedication for dental surgery.