Preoperative Psychological Preparation of Children

Innovative Program to Prevent Pediatric Chronic Postsurgical Pain: Patient Partner Feedback on Intervention Development

BACKGROUND

The risk of developing chronic postsurgical pain (CPSP) in youth is related to psychological factors, including preoperative anxiety, depression, patient/caregiver pain catastrophizing, and poor self-efficacy in managing pain. While interventions exist to address these factors, they are generally brief and educational in nature. The current paper details patient partner feedback on the development of a psychologist-delivered perioperative psychological program (PPP) designed to identify and target psychological risk factors for CPSP and improve self-efficacy in managing pain.

METHODS

Qualitative interviews were conducted with two patients and their caregivers to discuss their surgical and pain management experience and to advise on components of the PPP.

RESULTS

Reflexive thematic analysis of interviews generated the following themes, which were incorporated into the content and implementation of the PPP: caregiver involvement, psychological and physical strategies for pain management, biopsychosocial pain education, intervention structure, and supporting materials.

CONCLUSIONS

The development of a novel psychologist-led PPP is a promising approach to mitigate mental health risks associated with pediatric CPSP and potentially boost postoperative outcomes and family wellbeing. Integrating patient partner feedback ensures that the PPP is relevant, acceptable, and aligned with the needs and preferences of the patients it is designed to serve.

Improving Identification of Pediatric Emergence Delirium in the Post Anesthesia Care Unit: A Quality Improvement Opportunity

OBJECTIVE

This article offers a recommendation on how the Pediatric Assessment Emergence Delirium Scale (PAEDS) could be implemented in the post anesthesia care unit (PACU) to improve the assessment and treatment of pediatric emergence delirium (PED).

BACKGROUND

PED is an anticipated complication in the PACU characterized by mental confusion, irritability, disorientation, inconsolable crying, and prolonged postanesthetic recovery time. Although it is a short-lived phenomenon, it increases the risk for traumatic injuries and may lead to a decrease in overall parent satisfaction with their child's surgical experience.

METHOD

Implementation of the PAEDS in the PACU has the potential to improve the care and safety of the surgical pediatric patient population and could be a catalyst for PED process improvements. This tool has been used in various studies and has demonstrated the validity and reliability in the assessment of emergence delirium.

CONCLUSIONS

Clinical use of the PAEDS is not standard of practice, but considering the adverse effects of PED on patients, parents, and medical staff, a PAEDS protocol could be beneficial to the PACU.

Postoperative Maladaptive Behavior, Preoperative Anxiety and Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review

Over the years, the number of pediatric patients undergoing surgeries are increasing steadily. The types of surgery vary between elective to emergency with involvement of multidisciplinary teams. The development of day care surgery unit is expanding where the patients will only come to the hospital on the day of surgery and discharge home after such as satisfactory parameters achieved, minimal to no pain, minimal to no bleeding from surgical site and able to tolerate fluids. Hospitalization and surgery could contribute to significant psychological disturbance to the children. These issues are not being addressed as children have difficulty in conveying their problems and fear. They do however express it through negative behavioral changes.

Psychological Preparations Affecting the Emotions of Children with Developmental Disorders Toward Hospitals

BACKGROUND

The psychological preparation factors associated with positive or negative emotions in pediatric patients with developmental disorders are not well known. We aimed to clarify which psychological preparation factors affect positive (favorable) or negative (fear) emotions toward hospitals in pediatric patients with autism spectrum disorder (ASD) or attention deficit hypertensive disorder (ADHD), using the questionnaires for the patients and guardians.

METHODS

The questionnaires were sent by mail via prefectural patient-family groups to pediatric patients (6 to 15 years old; diagnosed with ASD or ADHD) and their guardians living in seven prefectures in Japan. Thereafter, we statistically analyzed the associations between the background factors or psychological preparations and the patients' positive or negative emotions toward the hospital.

RESULTS

The questionnaire results of 68 patients (age: 6-15 years; 15 = females; 53 = males) and their guardians indicated the main diagnoses for patients were ASD (n = 54) and ADHD (n = 14). Intellectual disability and hypersensitivity were positively associated with fear experiences in the hospital. In contrast, the staff's explanations during interventions negatively associated with patients' fear experiences. The psychological preparations performed by doctors during the medical checks were positively associated with the patient's positive emotions toward the hospital.

CONCLUSION

Regarding the psychological preparations for patients with ASD or ADHD, interpersonal communication with doctors and staff promotes positive emotions and reduces anxiety in the hospital.

Appropriate use of a beta-blocker in paediatric coronary CT angiography

BACKGROUND

There is no standard dose or protocol for beta-blocker administration as preconditioning in children undergoing coronary CT angiography.

METHODS

A total of 63 consecutive patients, with a mean age of 10.0±3.1 years, who underwent coronary CT angiography to assess possible coronary complications were enrolled in a single-centre, retrospective study. All patients were given an oral beta-blocker 1 hour before coronary CT angiography. Additional oral beta-blocker or intravenous beta-blocker was given to those with a high heart rate. We compared image quality, radiation exposure, and adverse events among the patients without additional beta-blocker, with additional oral beta-blocker, and with additional intravenous beta-blocker.

RESULTS

There were no significant differences in image quality or radiation exposure among the groups. The heart rate just before scanning was significantly correlated with image quality (p<0.001, r=-0.533) but was not correlated with radiation exposure (p=0.45, r=0.096). There were no adverse events related to any allergic reaction, thereby showing the effectiveness of the beta-blocker.

CONCLUSION

Initial oral beta-blocker administration (0.8 mg/kg/dose) should be administered to all children undergoing coronary CT angiography. Additional intravenous beta-blocker should be given to those with poor heart rate control to improve image quality without increasing radiation exposure or allowing adverse events.