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Yun L, Li Y, Yin L. Real-time procedure information sharing as a means to reduce perioperative anxiety in families of children undergoing elective surgery - a randomized controlled study. BMC Anesthesiol 2024; 24:199. [PMID: 38840039 PMCID: PMC11151527 DOI: 10.1186/s12871-024-02581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE To investigate whether the surgical process information sharing system could alleviate the parental anxiety during a pediatric selective operation. DESIGN Randomized controlled trial. METHODS A questionnaire survey was conducted one day before surgery for the enrolled participants. Family members assigned to the intervention group received real-time process information sharing through service reminders during the surgical period, while the control group received standard perioperative education. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality during the perioperative period, and the State of Cohesion-13 Scale (SOC-13) and Self-rating Anxiety Scale (SAS) were used to assess anxiety levels. Satisfaction levels during the perioperative period were assessed through a follow-up survey conducted one day after surgery. RESULTS The intervention group showed better scores in terms of PSQI, SOC-13, SAS, and postoperative satisfaction levels at various time points compared to the control group, with statistically significant differences observed (P < 0.05). CONCLUSION Real-time process information sharing is effective in reducing perioperative sleep disorders and anxiety among family members of pediatric patients, as well as improving satisfaction levels. This approach not only establishes a process and mechanism for effective doctor-patient communication but also helps implement continuous perioperative care, thereby optimizing internet healthcare services.
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Affiliation(s)
- Linjun Yun
- Department of Anesthesiology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yuanhong Li
- West China Tianfu Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Lu Yin
- Department of Anesthesiology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Kwa ZY, Li J, Loh DL, Lee YY, Liu G, Zhu L, Pikkarainen M, He H, Mali VP. An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation. JMIR Form Res 2024; 8:e52337. [PMID: 38363589 PMCID: PMC10907943 DOI: 10.2196/52337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. OBJECTIVE This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. METHODS Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. RESULTS The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. CONCLUSIONS ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404.
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Affiliation(s)
- Zhi Yin Kwa
- Department of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Jinqiu Li
- Nursing Department, Zhuhai Campus, Zunyi Medical University, Zhuhai, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dale Lincoln Loh
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Yang Yang Lee
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Guangyu Liu
- Integrated Health Promotion, Ministry of Health Office for Healthcare Transformation, Singapore, Singapore
| | - Lixia Zhu
- Hôpital Chinois de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Minna Pikkarainen
- Department of Health Technology and Rehabilitation and Department of Product Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, Oulu Business School, University of Oulu, Oulu, Finland
| | - Honggu He
- National University Health System, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vidyadhar Padmakar Mali
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
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Dost B, Komurcu O, Bilgin S, Turunc E, Ozden GG, Hancioglu S, Baris S. Is Preoperative Anxiety Affected by Watching Short Videos on Social Media? A Prospective Randomized Study. J Perianesth Nurs 2023; 38:758-762. [PMID: 36803738 DOI: 10.1016/j.jopan.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 01/06/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The purpose of this study was to investigate the impact of watching short videos in the preoperative waiting room on preoperative anxiety in children. DESIGN This study was designed as a prospective, randomized trial including 69 ASA I-II patients aged 5 to 12 years who were scheduled for elective surgery. METHODS The children were randomly allocated to two groups. The experimental group browsed short videos on a social media platform (eg, YouTube short, TikTok, Instagram reels) for 20 minutes in the preoperative waiting room, but the control group did not. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) at different time points: on arrival in the preoperative waiting room (T1), right before being taken to the operating room (OR) (T2), on entering the OR (T3), and during anesthesia induction (T4). The primary outcome of the study was children's anxiety scores at T2. FINDINGS The mYPAS scores at T1 were similar in both groups (P = .571). The mYPAS scores at T2, T3, and T4 were significantly lower in the video group than in the control group (P < .001). CONCLUSIONS Watching short videos on social media platforms in the preoperative waiting room lowered preoperative anxiety levels in pediatric patients aged 5 to 12.
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Affiliation(s)
- Burhan Dost
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Ozgur Komurcu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sezgin Bilgin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Esra Turunc
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Gaye Gamze Ozden
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sertac Hancioglu
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sibel Baris
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Gutkin PM, Skinner L, Jiang A, Donaldson SS, Loo BW, Oh J, Wang YP, von Eyben R, Snyder J, Bredfeldt JS, Breneman JC, Constine LS, Faught AM, Haas-Kogan D, Holmes JA, Krasin M, Larkin C, Marcus KJ, Maxim PG, McClelland S, Murphy B, Palmer JD, Perkins SM, Shen CJ, Terezakis S, Bush K, Hiniker SM. Feasibility of the Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) System for Anesthesia Avoidance in Pediatric Patients: A Multicenter Trial. Int J Radiat Oncol Biol Phys 2023; 117:96-104. [PMID: 37001762 DOI: 10.1016/j.ijrobp.2023.03.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The Audio-Visual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) system was the first published radiation therapy (RT)-compatible system to reduce the need for pediatric anesthesia through video-based distraction. We evaluated the feasibility of AVATAR implementation and effects on anesthesia use, quality of life, and anxiety in a multicenter pediatric trial. METHODS AND MATERIALS Pediatric patients 3 to 10 years of age preparing to undergo RT at 10 institutions were prospectively enrolled. Children able to undergo at least 1 fraction of RT using AVATAR without anesthesia were considered successful (S). Patients requiring anesthesia for their entire treatment course were nonsuccessful (NS). The PedsQL3.0 Cancer Module (PedsQL) survey assessed quality of life and was administered to the patient and guardian at RT simulation, midway through RT, and at final treatment. The modified Yale Preoperative Anxiety Scale (mYPAS) assessed anxiety and was performed at the same 3 time points. Success was evaluated using the χ2 test. PedsQL and mYPAS scores were assessed using mixed effects models with time points evaluated as fixed effects and a random intercept on the subject. RESULTS Eighty-one children were included; median age was 7 years. AVATAR was successful at all 10 institutions and with photon and proton RT. There were 63 (78%) S patients; anesthesia was avoided for a median of 20 fractions per patient. Success differed by age (P = .04) and private versus public insurance (P < .001). Both patient (P = .008) and parent (P = .006) PedsQL scores significantly improved over the course of RT for patients aged 5 to 7. Anxiety in the treatment room decreased for both S and NS patients over RT course (P < .001), by age (P < .001), and by S versus NS patients (P < .001). CONCLUSIONS In this 10-center prospective trial, anesthesia avoidance with AVATAR was 78% in children aged 3 to 10 years, higher than among age-matched historical controls (49%; P < .001). AVATAR implementation is feasible across multiple institutions and should be further studied and made available to patients who may benefit from video-based distraction.
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Affiliation(s)
- Paulina M Gutkin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California; Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Alice Jiang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Justin Oh
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Yi Peng Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - John Snyder
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Jeremy S Bredfeldt
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Louis S Constine
- Department of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Austin M Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jordan A Holmes
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Charlene Larkin
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen J Marcus
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Peter G Maxim
- Department of Radiation Oncology, University of California, Irvine, California
| | - Shearwood McClelland
- Departments of Radiation Oncology and Neurologic Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Blair Murphy
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University School of Medicine, Columbus, Ohio
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephanie Terezakis
- Department of Radiation Oncology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Karl Bush
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
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Mathias EG, Pai MS, Guddattu V, Bramhagen AC. Non-pharmacological interventions to reduce anxiety among children undergoing surgery: A systematic review. J Child Health Care 2023; 27:466-487. [PMID: 35098734 DOI: 10.1177/13674935211062336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A hospitalized child experiences anxiety more frequently as compared to non-hospitalized children. Surgery can be emotionally distressing for children, and subsequently their parents and caregivers, this distress can cause profound adverse impacts on children. We aimed to identify the effect of non-pharmacological interventions on children's (1-18 years) anxiety undergoing surgery. The following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Proquest, Web" of Science, and Cochrane Central Register of Controlled Trials were systematically searched for full-text articles. The review included 15 randomized controlled trials. The risk of bias was assessed using Cochrane Risk of Bias tool. The interventions included in the study were preoperative education, puppet play, therapeutic play, distraction activities, parental presence, and clown therapy. The review presents a narrative reporting of the findings. This review identifies that non-pharmacological interventions are effective in reducing anxiety among children undergoing surgery. There are a limited number of studies from developing countries. Further research is required to underpin the use of these interventions with children before surgery.
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Affiliation(s)
- Edlin Glane Mathias
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | | | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Tang X, Zhang M, Yang L, Tao X, Li Y, Wang Y, Wang X, Hu X. Individual cartoon video for alleviating perioperative anxiety and reducing emergence delirium in children: a prospective randomised trial. BMJ Paediatr Open 2023; 7:e001854. [PMID: 37407252 DOI: 10.1136/bmjpo-2023-001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Perioperative anxiety and emergence delirium (ED) in young children may cause a series of adverse events, which are worth investigating. Pharmacological treatments of anxiety and delirium remain uncertain, while non-pharmacological treatments lack personalization and pertinence. AIMS The aim of study was to determine whether an individual cartoon video can alleviate perioperative anxiety and reduce ED in young children undergoing adenoidectomy and tonsillectomy. METHODS Children between 3 and 7 years old undergoing adenoidectomy and tonsillectomy were randomly assigned to an individual cartoon video group (group V) or a control group (group C). In group V, an individual cartoon video of the child' s own choice was played throughout the whole waiting, anaesthesia induction and recovery periods. The children in group C were contacted through verbal conversation. The primary outcomes were anxiety measured by the Modified Yale Preoperative Anxiety Scale and ED assessed by the Paediatric Anaesthesia Emergence Delirium (PAED) scale. The secondary outcomes included cooperation during induction, postoperative pain and adverse events. RESULTS The incidence of anxiety were comparable in group V and group C at the holding area (T0) (26% vs 22%, p=0.323), but the incidence of anxiety of group V were significantly lower than those of group C at the time of entering the operating room (T1), during the induction of anaesthesia (T2) and leaving the post anaesthesia care unit (T6) (p<0.001, p<0.001, p<0.001) after intervention. The peak PAED score in group V was significantly lower than that in group C (12.00 (9.00-13.00) vs 13.50 (10.00-15.00), p=0.016). We found no significant differences in cooperation during induction, postoperative pain or the incidence of adverse events between the groups (2.00 (0.00-4.00) vs 3.00 (1.25-4.00), p=0.110; F=0.059, Pgroup=0.808; 3 (7.5%) vs 4 (10), p=0.692). CONCLUSIONS The individual cartoon video is an effective method of reducing perioperative anxiety and alleviating ED in children. TRIAL REGISTRATION NUMBER ChiCTR2200062300 (https://www.chictr.org.cn/index.aspx).
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Affiliation(s)
- Xinyu Tang
- Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China
| | - Muchun Zhang
- Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China
| | - Lizhuang Yang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui, China
| | | | - Yamei Li
- Anhui Medical University, Hefei, China
| | - Yi Wang
- Anhui Medical University, Hefei, China
| | - Xin Wang
- Anhui Medical University, Hefei, China
| | - Xianwen Hu
- Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China
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Musselman E, Shea K, Johnson L. Developmentally Appropriate Care of Pediatric Patients in the Perioperative Setting. AORN J 2023; 117:98-108. [PMID: 36705448 DOI: 10.1002/aorn.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 01/28/2023]
Abstract
Pediatric patients do not undergo procedures exclusively at pediatric specialty facilities. Many perioperative nurses will care for a pediatric patient at some point in their career. Children and their caregivers often experience elevated levels of anxiety during the perioperative experience. Possessing knowledge of the child's age and developmental stage and using effective communication techniques can decrease this anxiety. This article presents insights into the stages of pediatric cognitive and psychosocial development and special pediatric health care considerations. Approaching and interacting with a child in a manner appropriate for their age and developmental stage can foster a more trusting nurse-child-caregiver relationship and reassure the caregiver that the perioperative team is providing their child with safe, high-quality care. Also included are five hypothetical case studies that illustrate effective communication styles and developmentally appropriate techniques that personnel can apply during the pediatric patient's perioperative experience.
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Liu W, Xu R, Jia J, Shen Y, Li W, Bo L. Research Progress on Risk Factors of Preoperative Anxiety in Children: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169828. [PMID: 36011459 PMCID: PMC9407918 DOI: 10.3390/ijerph19169828] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 06/01/2023]
Abstract
Preoperative anxiety has adverse effects on children and negative impacts on postoperative rehabilitation. Anesthesiologists can accurately identify children with preoperative anxiety, and individualized intervention can effectively improve their psychological state and clinical prognosis. However, a comprehensive summary of the current available evidence has yet to be conducted. Searches were conducted in Medline databases from inception to March 2022. Primary studies that reported preoperative anxiety in children and its attendant effects on postoperative recovery and prognosis were screened and included. Among the 309 publications identified, 12 related studies (n = 3540 patients) met the eligibility criteria. The incidence of preoperative anxiety in children in the included studies ranged from 41.7% to 75.44%. While 16 influencing factors were identified, only 5 factors had a significant impact on preoperative anxiety in children: younger age (n = 8), parental anxiety (n = 7), negative previous hospitalizations (n = 3), less sociableness (n = 2), and surgical setting (n = 1). The current scoping review identified risk factors for preoperative anxiety in children. Healthcare workers should identify and manage preoperatively anxious children. There are still some factors that are controversial, and large-scale clinical studies are needed.
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Affiliation(s)
- Weiwei Liu
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Rui Xu
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ji’e Jia
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Yilei Shen
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Lunoe MM, Bolin AE, Drendel AL. An Evaluation of High Preprocedural Anxiety and Venipuncture Pain Experienced by Young Children. Pediatr Emerg Care 2021; 37:e621-e624. [PMID: 34591812 DOI: 10.1097/pec.0000000000002424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine if young children with high preprocedural anxiety experience increased pain at venipuncture. METHODS This was secondary analysis of prospectively obtained data from a randomized controlled trial comparing vapocoolant spray with jet-injected lidocaine for venipuncture pain. Children aged 1 to 6 years were enrolled and videotaped. Videos were reviewed and scored for anxiety using the modified Yale Preoperative Anxiety Scale score for preprocedural anxiety (score range, 23-100). High anxiety was defined as greater than 40. Pain at the time of venipuncture was scored using the Face, Legs, Activity, Cry, and Consolability scale (score range 0-10). Moderate to severe pain was defined as greater than 3. Logistic regression assessed patient factors associated with high preprocedural anxiety and evaluated the relationship between preprocedural anxiety and pain during venipuncture. RESULTS Two hundred five patients were enrolled; 59.5% of patients were male, and 53.7% were White. Mean age was 3.2 years. Prior to the procedure, 67% of patients had high anxiety. Patient age, race, sex, and previous venipuncture were not associated with increased odds of high anxiety. Moderate to severe pain at venipuncture was observed in 65% of children. High preprocedural anxiety was associated with increased odds of moderate to severe pain at venipuncture when controlled for patient characteristics (adjusted odds ratio, 4.62; 95% confidence interval, 2.03-8.54). CONCLUSIONS Most young children undergoing venipuncture experienced high preprocedural anxiety. Children with high preprocedural anxiety had increased odds of moderate to severe pain at venipuncture. Anxiety-reducing interventions should be explored to reduce pain experienced during venipuncture.
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Affiliation(s)
- Maren M Lunoe
- From the Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Ashley E Bolin
- McGaw Medical Center of Northwestern University at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Amy L Drendel
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Getahun AB, Endalew NS, Mersha AT, Admass BA. Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:485-494. [PMID: 33364873 PMCID: PMC7751437 DOI: 10.2147/phmt.s288077] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
Background Anesthesia and surgery are common sources of anxiety and stressful experiences in children. This unpleasant sensation depends on several factors. This study aimed to determine the magnitude of preoperative anxiety and associated factors in pediatrics patients at the University of Gondar Comprehensive Specialized Hospital North West Ethiopia 2020. Methods An institutional-based cross-sectional observational study was conducted from March to September 2020 at the University of Gondar Comprehensive Specialized Hospital. After obtaining ethical approval from the institutional review board. All consecutive ASA physical status I & II boys and girls with the age of 2–12 years scheduled for a variety of elective (general, urologic, ENT, ophthalmic and other surgical) operations were included. The level of anxiety was measured using the Modified Yale Preoperative Anxiety Scale short form (m-YPAS-SF) observational tool. Parental anxiety was assessed using Spielberger’s short version of state-trait anxiety. Binary logistic regression analysis was performed to identify the association between preoperative children’s anxiety and independent variables. The strength of the association was present by adjusted odds ratios. Results The magnitude of preoperative anxiety in children in the operation room was 75.44% (95% confidence interval (CI): 68.36, 81.34). Age (AOR: 3.83; 95% CI: 1.58, 9.30), previous surgery and anesthesia (AOR: 6.73, 95% CI: 1.25, 36.19), outpatient surgery (AOR: 5.16, 95% CI: 1.32, 20.23) and parental anxiety (AOR: 3.26, 95% CI: 1.30, 20.23) were significantly associated with preoperative children anxiety. Conclusion The magnitude of preoperative anxiety in pediatric patients was considerably high in our setup. Younger age, previous surgery and anesthesia, outpatient surgical setting, and parental anxiety were the independent risk factors for preoperative anxiety. Therefore, the operating staff should assess the child’s anxiety and should consider appropriate anxiety reduction methods during the preoperative visit of pediatric patients and their families.
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Affiliation(s)
- Amare Belete Getahun
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nigussie Simeneh Endalew
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abraham Tarekegn Mersha
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Biruk Adie Admass
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Topalel S, Orekici Temel G, Azizoğlu M. Evaluation of Preoperative Anxiety in Turkish Paediatric Patients and Validity and Reliability of the Turkish Modified Yale Preoperative Anxiety Scale. Turk J Anaesthesiol Reanim 2020; 48:484-490. [PMID: 33313588 PMCID: PMC7720823 DOI: 10.5152/tjar.2020.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Preoperative anxiety has been related with postoperative behaviour changes, and it is characterised by subjective feelings. The modified Yale Preoperative Anxiety Scale (mYPAS) is a tool, which indicates preoperative anxiety in children older than 2 years. The objective of this study was to investigate factors affecting the level of preoperative anxiety after conduct validity and reliability of the Turkish version of mYPAS. Methods After obtaining approval from the ethics committee, 330 children aged 5-16 years were included in the study. Relationships between possible anxiety factors and anxiety levels were evaluated after validity and interrater reliability of the Turkish version. Results The intraclass correlation coefficient between the three observers was 0.9949 (95% confidence interval [CI]: 0.9939-0.9958) for the playroom assessments and 0.9952 (95% CI: 0.9942-0.9960) for the operating room assessments. The anxiety level was significantly lower in premedicated patients (p<0.001). There was a negative correlation between age and anxiety level (p<0.001, r=-0.350). Conclusion The Turkish version of mYPAS has high validity and reliability and is suitable for use in the paediatric population of our country. Premedication significantly decreased preoperative anxiety, and younger patients tended to have higher anxiety level. For the 5-12 years age range, the level of anxiety decreased with age. More clinical studies are needed to investigate factors that contribute to preoperative anxiety.
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Affiliation(s)
- Selen Topalel
- Department of Anaesthesiology and Reanimation, Bingöl State Hospital, Bingöl, Turkey
| | - Gülhan Orekici Temel
- Department of Biostatistics and Bioinformatics, Mersin University School of Medicine, Mersin, Turkey
| | - Mustafa Azizoğlu
- Department of Anaesthesiology and Reanimation, Mersin University School of Medicine, Mersin, Turkey
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Abstract
AIMS Several kinds of drugs have been investigated in preschool children as a preanesthetic sedation after various routes of administration for surgeries. This study aims to compare the efficacy of promethazine and oral midazolam for premedication in children aged 3 to 9 years who were scheduled for surgeries. METHODS This is a double-blind randomized controlled study conducted on 93 patients between the age of 3 and 9 years at Loresten University of Medical Sciences Teaching Hospital, Khoramabad, Iran. The subjects were grouped into P (promethazine), M (midazolam), and C (control). About 0.3 mg/kg of oral promethazine was administered to patients in group P, 0.5 mg/kg of oral midazolam was administered to patients in group M, and 3 mL of normal saline as placebo was administered to patients in group C. Patient satisfaction, sedation and emotional score, systolic blood pressure (SBP), diastolic blood pressure, respiratory rate (RR), and heart rate (HR) were recorded. RESULTS There was no statistically significant difference among the 3 groups. However, the period after medication, it was observed that SBP, diastolic blood pressure, RR, and HR in group C were statistically significantly higher than those in groups M and P. These 2 groups are similar in terms of SBP, RR, and HR. The emotional scores were comparable for the 2 groups. It was between 3.97 ± 0.6 to 1.7 ± 0.5 in group M and from 3.45 ± 1.17 to 2.745 ± 0.997 in group P in a Kruskal-Wallis test. CONCLUSIONS This study shows that both test groups reduce stress at the time of anesthetic induction and separation from their parents with similar effect. Both of the anesthetics are easily administered without the necessity of an additional equipment. A shorter period to maximal sedation for midazolam is an advantage, thus, making the drug helpful, mostly in the outpatient setting.
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Pearce JI, Brousseau DC, Yan K, Hainsworth KR, Hoffmann RG, Drendel AL. Behavioral Changes in Children After Emergency Department Procedural Sedation. Acad Emerg Med 2018; 25:267-274. [PMID: 28992364 PMCID: PMC5842101 DOI: 10.1111/acem.13332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/19/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative postdischarge behaviors. Predictors of negative behaviors were evaluated, including anxiety. METHODS This was a prospective cohort study of children receiving intravenous ketamine sedation for ED fracture reduction. The child's anxiety prior to sedation was measured with the Modified Yale Preoperative Anxiety Scale. Negative behavioral changes were measured with the Post-Hospitalization Behavior Questionnaire 1 to 2 weeks after discharge. Descriptive statistics and odds ratios (ORs) were calculated. Chi-square test was used for comparisons between groups. Multivariable logistic regression models evaluated predictors of negative behavioral change after discharge. RESULTS Ninety-seven patients were enrolled; 82 (85%) completed follow-up. Overall, 33 (40%) children were observed to be highly anxious presedation and 18 (22%) had significant negative behavior changes after ED discharge. Independent predictors for negative behaviors were high anxiety (OR = 9.0, 95% confidence interval [CI] = 2.3-35.7) and nonwhite race (OR = 6.5, 95% CI = 1.7-25.0). CONCLUSION For children undergoing procedural sedation in the ED, two in five children have high preprocedure anxiety and almost one in four have significant negative behaviors 1 to 2 weeks after discharge. Highly anxious and nonwhite children have increased risk of negative behavioral changes that have not been previously recognized in the ED setting.
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Affiliation(s)
- Jean I. Pearce
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - David C. Brousseau
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Ke Yan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
- Division of Quantitative Health Sciences/Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Keri R. Hainsworth
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Raymond G. Hoffmann
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
- Division of Quantitative Health Sciences/Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Amy L. Drendel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
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Moura LAD, Dias IMG, Pereira LV. Prevalence and factors associated with preoperative anxiety in children aged 5-12 years. Rev Lat Am Enfermagem 2017; 24:S0104-11692016000100339. [PMID: 27305179 PMCID: PMC4916978 DOI: 10.1590/1518-8345.0723.2708] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/26/2015] [Indexed: 04/28/2023] Open
Abstract
Objective: to estimate the prevalence and factors associated with preoperative anxiety in
children who wait for outpatient surgery. Method: cross-sectional analysis of baseline data of a prospective cohort study that
investigates the predictors of postoperative pain in children aged 5-12 years
submitted to inguinal and umbilical hernia repair. It was selected 210 children,
which were interviewed in the preoperative holding area of a general hospital.
Anxiety was evaluated using the modified Yale Preoperative Anxiety Scale (mYPAS).
Sociodemographic and clinical variables were analyzed as exposure and anxiety
(mYPAS final score>30) as outcome. Logistic regression was used to identify
factors associated with preoperative anxiety. Results: forty-two percent (42.0%) of children presented preoperative anxiety (CI95%:
35.7%-48.6%), with mean scores equal to 30.1 (SD=8.4). Factors associated with
preoperative anxiety were: age group of 5-6 years (OR=2.28; p=0.007) and
socioeconomic status classified as class C (OR=2.39; p=0.016). Conclusion: the evaluation of children who wait for outpatient surgery should be
multidimensional and comprise information on age and socioeconomic status, in
order to help in the identification and early treatment of preoperative
anxiety.
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Affiliation(s)
- Louise Amália de Moura
- MSc, Assistant Professor, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil. , Universidade Federal de Goiás, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia GO , Brazil
| | - Iohanna Maria Guimarães Dias
- Undergraduate student in Nursing, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil., Universidade Federal de Goiás, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia GO , Brazil
| | - Lilian Varanda Pereira
- PhD, Adjunct Professor, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, Brazil., Universidade Federal de Goiás, Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia GO , Brazil
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Ozdogan HK, Cetinalp S, Kuran G, Tugal O, Tahiroglu M, Herdem UE, Haytoglu S. The effects of maternal presence during anesthesia induction on salivary cortisol levels in children undergoing tonsillectomy and/or adenoidectomy. J Clin Anesth 2017; 39:64-66. [DOI: 10.1016/j.jclinane.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022]
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McMullen KP, Hanson T, Bratton J, Johnstone PAS. Parameters of anesthesia/sedation in children receiving radiotherapy. Radiat Oncol 2015; 10:65. [PMID: 25889312 PMCID: PMC4362639 DOI: 10.1186/s13014-015-0363-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background Previous reports establish low risk of complications in pediatric treatments under anesthesia/sedation (A/S) in the outpatient setting. Here, we present our institutional experience with A/S by age and gender in children receiving daily proton RT. Methods After Institutional Review Board approval, we reviewed our center’s records between 9/9/2004 and 6/30/2013 with respect to age and gender of A/S requirement in our pediatric patients (defined as patients ≤18 years of age). Results Of 390 patients treated in this era, 182 were girls. Children aged ≤3 invariably required A/S; and by age 7–8, approximately half of patients do not. For pediatric patients ≥ 12 years of age, approximately 10% may require A/S for different reasons. There was no difference by gender. Conclusions Beyond age 3, the requirement for A/S decreases in an age-dependent fashion, with a small cadre of older children having difficulty enough with sustained immobilization that A/S is necessary. In our experience, there is no difference in A/S requirement by gender.
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Affiliation(s)
- Kevin P McMullen
- IU Health Proton Therapy Center, Bloomington, Indiana. .,Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Tara Hanson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | | | - Peter A S Johnstone
- IU Health Proton Therapy Center, Bloomington, Indiana. .,Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
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Kovac M. Music Interventions for the Treatment of Preoperative Anxiety. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2014. [DOI: 10.1080/15398285.2014.902282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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