Preparatory information reduces gastroscopy-related stress in children as confirmed by salivary cortisol

Examination tolerance, pre-examination anxiety, knowledge needs and cooperation in gastroscopic examinees: A prospective, correlational analysis in a health screening population

AIM

To explore the correlations between examination tolerance and anxiety, knowledge needs and examination cooperation in sedation-free gastroscopy examinees.

DESIGN

Cross-sectional survey using convenience sampling.

METHODS

A total of 170 healthy adults who underwent sedation-free gastroenteroscopy were asked to complete a visual analogue scale (VAS) to rate their examination tolerance, the state anxiety questionnaire (S-AI), a newly designed knowledge needs questionnaire and a cooperation questionnaire.

RESULTS

The VAS score was 4.47 ± 1.96, the state anxiety score was 39.46 ± 9.81, the total score for knowledge needs was 44.89 ± 11.02, and the average cooperation score was 2.47 ± 0.38. The VAS score during the examination positively correlated with the pretest state anxiety score and pretest knowledge needs score and negatively correlated with the examination cooperation score. The results of multiple linear regression analysis showed that after undergoing the examination for the first time, anxiety, body position and swallowing control were the main factors influencing the examination tolerance of sedation-free gastroscopy examinees.

PATIENT OR PUBLIC CONTRIBUTION

We would like to thank the staff and patients of the participating hospital for their assistance and cooperation in performing the current study.

Children's preoperative stress according to the parental presence evaluated by salivary cortisol and mYPAS: quasi-randomized trial

OBJECTIVE

The main objective of this study was to compare stress and anxiety levels in children undergoing surgical procedures with or without parental presence at induction of anesthesia by measuring salivary cortisol levels and applying the mYPAS.

METHOD

Quasi-randomized trial with children aged 5-12 year, with ASA physical status I, II, or III, undergoing elective surgery. According to parents' willingness, the pair were defined as accompanied or unaccompanied group. Chi-square, Fisher's exact tests, Student's t test, Mann-Whitney, Hodges-Lehman and Spearman's tests were used for statistical analyzes.

RESULTS

We included 46 children; 63% were preschool children mostly accompanied by their mothers (80%). The median mYPAS score was 37.5 (quartile range, 23.4-51.6) in unaccompanied children, and 55.0 (quartile range, 27.9-65.0) in accompanied children, with an estimated median difference of +11.8 (95% CI of 0 to 23.4; p = 0.044). There were no significant differences in the mean salivary cortisol levels.

CONCLUSION

The level of anxiety was higher in accompanied children. There were no differences in salivary cortisol levels between both groups. Brazilian Registry of Clinical Trials (ReBEC): RBR-9wj4qvy.

Investigating Non-Pharmacological Stress Reduction Interventions in Pediatric Patients Confirmed with Salivary Cortisol Levels: A Systematic Review

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.

Measuring Children's Stress via Saliva in Surgical and Endoscopic Procedures and Its Measurement Intention in the Community: Reality-Future Prospects

(1) Background: Children who undergo surgical or endoscopic procedures display high levels of stress, and various means are applied to reduce their anxiety. Salivary cortisol (S Cortisol) and salivary alpha-amylase (SAA) are often used as a valid biomarker of stress. The primary purpose of the study was the investigation of stress levels through S Cortisol and S amylase after intervention in surgical or endoscopic procedures (gastroscopy-colonoscopy). The secondary outcomes were the investigation of the intention to adopt new methods of saliva sampling. We collected saliva samples from children subjected to invasive medical procedures, with the aim of applying the Theory of Planned Behavior (TPB) as an intervention means to provide information and education to both parents and children undergoing stressful situations, and assess its efficacy in reducing stress levels. We also aimed at acquiring a better understanding of the acceptability of noninvasive biomarker collection in community settings. (2) Methods: The sample of this prospective study comprised 81 children who underwent surgical or endoscopic procedures at the Attikon General University Hospital, Athens, Greece and 90 parents. The sample was divided into two groups. The first, 'Group Unexplained', was not provided any information or education about the procedures, while the second, 'Group Explained', was informed and educated based on TPB. Thereafter, 8-10 weeks after intervention, the Theory of Planned Behavior questions were re-completed by the 'Group Explained'. (3) Results: Significant differences were detected in cortisol and amylase values between the two groups postoperatively after applying the TPB intervention. Saliva cortisol was reduced by 8.09 ng/mL in the 'Group Explained' while in the 'Group Unexplained' it was reduced by 4.45 ng/mL (p < 0.001). Salivary amylase values decreased by 9.69 ng/mL in the 'Group Explained' after the intervention phase of the study, while in the 'Group Unexplained' they increased by 35.04 ng/mL (p < 0.001). The regression explains 40.3% (baseline) and 28.5% (follow-up) of parental intention. The predictive factor of parental intention (baseline) is attitude (p < 0.001) and follow-up is behavioral control (p < 0.028) and attitude (p < 0.001). (4) Conclusions: Providing proper education and information for parents has a positive effect on reducing children's stress levels. Changing parental attitudes towards saliva collection plays the most important role, since a positive attitude can influence intention and ultimately participation in these procedures.

The Evolution of Sedation for Pediatric Gastrointestinal Endoscopy

Sedation for pediatric endoscopy has evolved from an endoscopist-administered component of procedures to an almost entirely anesthesiologist-supported endeavor. Nevertheless, there are no ideal endoscopist or anesthesiologist-administered sedation protocols, and wide practice variation exists in both models. Furthermore, sedation for pediatric endoscopy, whether administered by endoscopists or anesthesiologists, remains the highest risk to patient safety. This underscores the importance of both specialties identifying best sedation practices together that can safeguard patients while maximizing procedural efficiency and minimizing costs. In this review, the authors discuss specific levels of sedation for endoscopy and the risks and benefits of various regimens.

Development and validation of a prediction model for preoperative anxiety in children aged 2-12 years old

BACKGROUND

Children with preoperative anxiety are at risk of perioperative adverse events, such as reflux aspiration, prolonged induction time, wake agitation, and delirium. Identifying children at high risk of severe preoperative anxiety may help anesthesiologists intervene and manage them in advance.

AIM

The authors hypothesized that the risk of developing serious preoperative anxiety in children is predictable by variables related to basic information about the parent and child. We developed a clinical prediction model to identify patients vulnerable to severe preoperative anxiety among children aged 2-12 years.

METHODS

We enrolled patients aged 2-12 years who underwent elective surgery under general anesthesia and divided them into derivation (n = 340, 70.8%) and validation (n = 140, 29.2%) groups. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale, and a high level of preoperative anxiety was defined as a score of >30. The following predictors were collected preoperatively: gender, age, weight, children's education level, only child, history of surgery, waiting time in the anesthesia waiting area, parental education level, parental anxiety, whether venous access had been established in the ward, and whether they had received anti-anxiety interventions. A prediction model was built using binary logistic regression analysis; bootstrap was applied for internal validation, and external validation was performed using the validation datasets.

RESULTS

The prediction model had good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.961 (95% CI = 0.943-0.979) and 0.896 (95% CI = 0.842-0.950) in the derivation and validation cohorts, respectively. The predictive variables included in the final clinical model were pharmacological intervention (OR = 0.008, 95% CI = 0.002-0.025), nonpharmacological intervention (OR = 0.342, 95% CI = 0.104-1.127), parental education level (OR = 0.211, 95% CI = 0.108-0.411), parental anxiety (OR = 6.15, 95% CI = 2.396-15.786), only child (OR = 2.417, 95% CI = 1.065-5.488), history of surgery (OR = 3.513, 95% CI = 1.137-10.860), and age (OR = 0.692, 95% CI = 0.500-0.957).

CONCLUSIONS

In this study, a clinical prediction model was developed and validated for the first time. The proposed clinical prediction model can help doctors identify children most likely to develop a high level of preoperative anxiety.

CLINICAL TRIAL REGISTRATION IDENTIFIER

ChiCTR2100054409 (https://www.chictr.org.cn/index.aspx).

Is correlation between plasma and salivary cortisol levels an important indicator of stress?: A meta-analysis study

The purpose of this study was to examine the practical importance of the correlation values between plasma and salivary cortisol levels using meta-analysis study. In this way, researchers focusing on cortisol levels in different individuals can use more systemic, practical and reliable evidence than using just salivary or plasma cortisol levels separately. For this purpose, correlational studies from 2000 up to now were collected and analyzed by meta-analysis. Results based on 18 effect sizes (n = 743) revealed that effect sizes of the correlations between plasma and salivary cortisol levels represented large effects. The overall combined effect size (Hedges's = 1.55) also represented a large effect. This finding indicates the practical importance of the correlation values for stress studies. The use of the correlation values for examining the cortisol levels in stress studies will be discussed in detail.