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Baek J, Kim YM. The Impact of Parental Presence on Emergence Delirium in Pediatric Patients After General Anesthesia: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024; 39:475-483. [PMID: 38219079 DOI: 10.1016/j.jopan.2023.10.002] [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: 02/02/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE This study reviewed existing literature on parental presence in cases of pediatric patients after general anesthesia and explored its effect on emergence delirium (ED) in the postanesthesia care unit (PACU). DESIGN Systematic review and meta-analysis. METHODS After protocol registration, we searched the PubMed, EMBASE, CINHAL, Web of Science, SCOPUS, and CENTRAL databases. Two authors independently searched and selected the relevant studies, assessed their risk of bias, and abstracted the data. The primary outcome was ED, and the additional outcome was pain. We provided the narrative synthesis and meta-analysis results. FINDINGS Of the 296 articles retrieved, 6 were included in the narrative synthesis, and 5 were used for the meta-analysis. Four studies were randomized controlled trials, and two studies were nonrandomized controlled trials. There were 348 pediatric patients in the parental presence group and 314 pediatric patients in the usual care group. Parental presence effectively reduced the ED score (mean difference, -0.58; 95% confidence interval [CI], -0.84 to -0.31; P < .001). The ED incidence rate (log odds ratio, -0.58; 95% CI, -1.24 to 0.09; P = .090) and pain score (standardized mean difference, -0.24; 95% CI, -0.57 to 0.10; P = .163) were lower in the parental presence group than in the usual care group. However, the differences were not statistically significant. CONCLUSIONS The presence of parents in the PACU can reduce ED in pediatric patients. Therefore, parental presence may be a useful intervention in the PACU.
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Affiliation(s)
- Jihyun Baek
- College of Nursing, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Young Man Kim
- College of Nursing, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea.
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Shon S, Kang M. Nursing experiences and knowledge of paediatric delirium: Analysing knowledge-practice gaps. Nurs Crit Care 2024. [PMID: 38516768 DOI: 10.1111/nicc.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Delirium commonly occurs in paediatric patients with acute critical illness and negatively affects clinical outcomes. Variations in delirium knowledge levels and its management have been noted among nurses. AIMS This study investigated nurses' experiences and knowledge levels regarding paediatric delirium. Additionally, we aimed to assess the gap between knowledge levels and practical experiences with paediatric delirium. STUDY DESIGN This cross-sectional descriptive study conveniently sampled paediatric nurses from a university hospital in South Korea between September 2022 and March 2023. Nursing experiences with paediatric delirium and delirium knowledge levels were measured using structured survey questionnaires. Delirium knowledge was scored 0 to 47, and higher scores indicated higher levels of delirium-related knowledge. Data were analysed using descriptive statistics and presented as mean, standard deviation, frequency and percentage. RESULTS A total of 127 paediatric nurses participated in this study; 40.2% had experience with 1-5 delirium cases in the previous year, and 86.6% (n = 110) had never used assessment tools for paediatric delirium assessment. The mean total delirium knowledge score was 34.45 ± 5.4; the mean scores of knowledge regarding aetiology, signs and symptoms and nursing management of delirium were 8.93 ± 1.31, 13.24 ± 2.81 and 12.3 ± 2.7, respectively. Interventions associated with a lower level of delirium-related knowledge and a lower performance rate included avoiding restraint use and maintaining hydration and electrolyte levels. Interventions associated with a higher level of delirium-related knowledge but a lower rate of performance comprised providing orientation, offering emotional support, allowing participants to stay with family members and administering medications to manage delirium. CONCLUSIONS Although nurses working in paediatric units exhibited high rate of delirium nursing care, there was the gap between their delirium-related knowledge and practice. Nurses need to be aware of the insufficient part of delirium care, and paediatric delirium education should be reinforced. RELEVANCE TO CLINICAL PRACTICE Preventing, assessing and systematically managing paediatric delirium is crucial, and considering the study results, delirium education among nurses is needed.
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Affiliation(s)
- Soonyoung Shon
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Minkyung Kang
- College of Nursing, Ajou University, Suwon, Republic of Korea
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Grigoropoulou M, Kapetanakis EI, Attilakos A, Charalampopoulos A, Dimopoulou A, Vamvakas E, Mavrigiannaki E, Zavras N. Investigating Non-Pharmacological Stress Reduction Interventions in Pediatric Patients Confirmed with Salivary Cortisol Levels: A Systematic Review. Pediatr Rep 2023; 15:349-359. [PMID: 37368364 DOI: 10.3390/pediatric15020031] [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: 05/05/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
For many children, hospitalization can lead to a state of increased anxiety. Being away from home, the invasive procedures undertaken, and the uncertainty of the outcome cause an uncomfortable situation in anticipation of real or imagined hazards. This systematic review aims to assess current evidence on the types of non-pharmacological interventions used and their impact on children's anxiety or distress levels when they visit the hospital for planned or unplanned admissions. The Databases PubMed, Psych INFO, and Google Scholar were queried for papers published from January 2000 to March 2023 reporting the use of non-pharmacological interventions interacting with children in hospital or clinical environments and confirmed with saliva cortisol levels. A total of nine studies were retrieved. Across these studies, four different strategies of non-pharmacological interventions were used. Anxiety and distress were found to be reduced in the majority of the studies as confirmed with salivary cortisol. Overall, there is evidence that non-pharmacological interventions hold a promising role in reducing levels of anxiety or distress in children as confirmed with saliva cortisol. However, research on saliva cortisol as a tool of anxiety measurement requires higher quality studies to strengthen the evidence base.
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Affiliation(s)
| | - Emmanouil I Kapetanakis
- Department of Thoracic Surgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece
| | - Achilleas Attilakos
- Third Department of Pediatrics, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece
| | - Anestis Charalampopoulos
- Third Department of Surgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece
| | - Efstratios Vamvakas
- Second Department of Critical Care, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece
| | - Eleftheria Mavrigiannaki
- Department of Pediatric Surgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, 12462 Athens, Greece
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Intervention to Reduce Anxiety Pre- and Post-Eye Surgery in Pediatric Patients in South Korea: A Preliminary Quasi-Experimental Study. CHILDREN 2022; 9:children9010065. [PMID: 35053690 PMCID: PMC8774770 DOI: 10.3390/children9010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
In this study, we aimed to identify the effect of preoperative information on postoperative anxiety among children undergoing one-day eye surgery. We utilized a nonequivalent control group and a pretest–posttest quasi-experimental design. The participants were 15 children in the experimental group and 15 children in the control group. Preoperative information was provided to the experimental group in the waiting room. Anxiety level was measured using the Children’s Emotional Manifestation Scale and pulse rate. For pulse rate, there were no statistically significant differences between the groups. In the behavioral anxiety response, there were statistically significant differences between the experimental and control groups (Z = −4.15, p < 0.001). The results suggest that the provision of preoperative information can be an effective intervention for reducing postoperative anxiety and improving the health of children undergoing surgery.
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Battah H, AlZoraigi U, Shubbak F. Effectiveness of preoperative tour to a simulated anaesthesia induction at operating theatre in reducing preoperative anxiety in children and their parents: a pragmatic, single-blinded, randomised controlled trial/ King Fahad Medical City. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:397-403. [DOI: 10.1136/bmjstel-2020-000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate the effectiveness of a preoperative tour to a simulated anaesthesia induction at operating theatre on reducing children’s and parents’ preoperative anxiety.DesignA pragmatic, single-centre, assessor-blinded, randomised controlled trial.SettingIn preoperative anaesthesia clinic and the operating room at a tertiary care centre in Saudi Arabia.ParticipantsOne hundred and sixteen children–parents dyads (pairs) (n=57) intervention group (IG); (n=59) control group (CG) with children aged 4–14 years who were planned for day case procedures under general anaesthesia.InterventionsParticipants’ dyads were randomly allocated through a computer to receive either a preoperative tour to a real operating theatre and simulate anaesthesia induction or standard of care.Main outcome measureThe primary study outcome was children’s anxiety levels as measured by the modified-Yale Preoperative Anxiety Scale (m-YPAS), and the parent’s anxiety level as assessed by the Beck Anxiety Inventory Scale. The children’s anxiety levels were measured at two time points, the preoperative holding area (T0) and before the anaesthesia induction (T1), and the parents’ anxiety level was measured after the anaesthesia induction. The secondary outcomes were the prevalence of preoperative anxiety and children’s somatic signs of anxiety including heart rate and systolic blood pressure.ResultsThe Mann-Whitney U test of m-YPAS scores showed significant differences in the children’s anxiety levels between the CG and IG at T0 (Z −5.009); p<0.01) and T1 (Z −6.599); p<0.01). BIAS analysis revealed a significant difference in the parents’ anxiety level between the CG and IG (Z −4.353); p<0.01). The prevalence of children’s anxiety was reported by 55 (93.2%) in the CG compared with 25 (43.9%) in the IG, with a statistically significant difference (p<0.001).ConclusionThe preoperative simulated anaesthesia induction was effective in reducing preoperative anxiety in children and their parents.
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Kim HJ, Kim DH. [Factors associated with Pediatric Delirium in the Pediatric Intensive Care Unit]. CHILD HEALTH NURSING RESEARCH 2019; 25:103-111. [PMID: 35004403 PMCID: PMC8650920 DOI: 10.4094/chnr.2019.25.2.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 11/25/2022] Open
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In W, Kim YM, Kim HS, Hong S, Suh Y, Cha Y, Kim N, Kim J, Kang H, Kwon H, Kim Y, Park W. The Effect of a Parental Visitation Program on Emergence Delirium Among Postoperative Children in the PACU. J Perianesth Nurs 2018; 34:108-116. [PMID: 30005899 DOI: 10.1016/j.jopan.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/31/2018] [Accepted: 04/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to examine the effects of parental presence on the incidence of emergence delirium (ED) of children in the postanesthesia care unit (PACU). DESIGN A quasi-experimental pretest and post-test study with nonequivalent and nonsynchronized control groups. METHODS About 93 children aged 3 to 6 years undergoing general anesthesia for tonsillectomy were divided into two groups: parental presence and absence. ED was recorded using the Pediatric Anesthesia Emergence Delirium Scale at 0, 10, 20, and 30 minutes after PACU admission. FINDINGS ED score at each time point in the experimental group was lower than the control group, but not statistically significant. ED score in the experimental group significantly decreased over time (F = 6.98; P = .010). CONCLUSIONS Parental visitation programs could be effective on the degree of ED in children in the PACU setting. This result may contribute to the establishment of PACU visitation program policy in South Korea.
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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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Reduction of Postanesthetic Pediatric Distress: A Coordinated Approach. J Perianesth Nurs 2017; 33:312-318.e1. [PMID: 29784261 DOI: 10.1016/j.jopan.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/11/2016] [Accepted: 11/20/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Preoperative anxiety in children is associated with postoperative distress in recovery. Both are predictors of long-term maladaptive behavior. Remedies have been suggested to modify individual risk factors, but overall strategy is lacking. DESIGN An approach to anxiety reduction coordinated throughout the hospital experience has been developed in our day-stay pediatric surgical unit. METHODS There is a preadmission familiarization visit. On admission, time is spent in a playroom with other children. Anxiety is recorded using the modified Yale Preoperative Anxiety Scale. Children are distracted with an activity book during propofol induction. They are allowed to wake naturally, and emergence state is scored. FINDING The incidence of emergence distress is low in our study. Of 68 children, only one exhibited emergence delirium and three had inconsolable crying. CONCLUSIONS Important elements in reducing emergence distress are preadmission visit, use of a playroom, effective analgesia, anesthetic maintenance without short-acting volatiles, and undisturbed recovery with a parent present for reassurance.
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Abstract
Preoperative anxiolysis is important for children scheduled for surgery. The nature of the anxiety depends on several factors, including age, temperament, past hospitalizations, and socioeconomic and ethnic backgrounds. A panoply of interventions effect anxiolysis, including parental presence, distraction, and premedication, although no single strategy is effective for all ages. Emergence delirium (ED) occurs after the use of sevoflurane and desflurane in preschool-aged children in the recovery room. Symptoms usually last approximately 15 minutes and resolve spontaneously. The Pediatric Anesthesia Emergence Delirium scale is used to diagnose ED and evaluate therapeutic interventions for ED such as propofol and opioids.
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Affiliation(s)
- Richard J Banchs
- Department of Anesthesiology (MC515), University of Illinois Medical Center, Children's Hospital University of Illinois, 1740 West Taylor Street, Suite 3200 West, Chicago, IL 60612-7239, USA
| | - Jerrold Lerman
- Department of Anesthesia, Women and Children's Hospital of Buffalo, SUNY at Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA; Department of Anesthesia, Strong Medical Center, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Narayanasamy AK, Ghori A. Emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth 2013; 111:121. [PMID: 23794655 DOI: 10.1093/bja/aet183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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