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Gil Mayo D, Sanabria Carretero P, Gajate Martin L, Alonso Calderón J, Hernández Oliveros F, Gomez Rojo M. Parental Presence during Induction of Anesthesia Improves Compliance of the Child and Reduces Emergence Delirium. Eur J Pediatr Surg 2022; 32:346-351. [PMID: 34243210 DOI: 10.1055/s-0041-1732321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Preoperative stress and anxiety in pediatric patients are associated with poor compliance during induction of anesthesia and a higher incidence of postoperative maladaptive behaviors. The aim of our study was to determine which preoperative preparation strategy improves compliance of the child during induction and decreases the incidence and intensity of emergence delirium (ED) in children undergoing ambulatory pediatric surgery. MATERIALS AND METHODS This prospective observational study included 638 pediatric American Society of Anesthesiologists I-II patients who underwent ambulatory pediatric surgery, grouped into four preoperative preparation groups: NADA (not premedicated), MDZ (premedicated with midazolam), PPIA (parental presence during induction of anesthesia), and PPIA + MDZ. The results were subsequently analyzed in four age subgroups: Group 1 (0-12 months), Group 2 (13-60 months), Group 3 (61-96 months), and Group 4 (> 96 months). Preoperative anxiety (modified Yale Preoperative Anxiety Scale [m-YPAS]), compliance of the child during induction (Induction Compliance Checklist [: ICC]), and ED (Pediatric Anesthesia Emergence Delirium scale) were analyzed in each group. RESULTS Eighty-one percent of patients in the PPIA + MDZ preparation group presented a perfect compliance during the induction of anesthesia (ICC = 0), less preoperative anxiety (mean score m-YPAS = 26), less probability of ED (odds ratio: 10, 5 [3-37.5]; p < 0.05), and less ED intensity compared with the NADA group (1.2 vs. 5.8; p = 0.001). CONCLUSION PPIA associated with midazolam premedication improves compliance during induction and decreases the incidence and intensity of ED.
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Affiliation(s)
- Diego Gil Mayo
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Luis Gajate Martin
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jose Alonso Calderón
- Department of Pediatric Surgery, Hospital Universitario Niño Jesús and H. Quironsalud Madrid, Spain
| | | | - María Gomez Rojo
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Vieco-García A, López-Picado A, Fuentes M, Francisco-González L, Joyanes B, Soto C, Garcia de la Aldea A, Gonzalez-Perrino C, Aleo E. Comparison of different scales for the evaluation of anxiety and compliance with anesthetic induction in children undergoing scheduled major outpatient surgery. Perioper Med (Lond) 2021; 10:58. [PMID: 34903293 PMCID: PMC8670148 DOI: 10.1186/s13741-021-00228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Anxiety in children triggered by a scheduled surgical intervention is a major issue due to its frequency and consequences. Preoperative anxiety is associated with increased patient fear and agitation on anesthetic induction. The aim of this study is to compare three preoperative anxiety scales for children undergoing elective outpatient surgery, and to correlate each of these tools with the degree of patient compliance on induction, as assessed by the Induction Compliance Checklist (ICC). METHODS An observational prospective study was performed on a cohort of children with ages between 2 and 16 years old, scheduled for outpatient surgery. Anxiety was assessed upon arrival to the hospital (M0), during transfer to the surgical unit (M1), and in the operating room during anesthetic induction (M2). Anxiety in the parents (measured with the State-Trait Anxiety Inventory, STAI) and in the children (measured with the Spence Anxiety Scale-Pediatric, SCAS-P, the State-Trait Anxiety Inventory Children, STAIC, and Modified Yale Preoperative Anxiety Scale, m-YPAS) was assessed. Compliance with anesthetic induction was assessed with ICC. RESULTS The study included 76 patients (72.4% male, median age 7.9 years). Anxiety scores (m-YPAS) increased as the moment of surgery approached, being greater at the entrance to the surgical unit (M0 = 26.1 ± 9.5; M1 = 31.8 ± 18.1; M2 = 33.5 ± 21.1). A strong correlation was found between ICC scale and m-YPAS at M1 (0.738) and M2 timepoints (0.794), but not with the rest of scales at M0. CONCLUSIONS Standard anxiety assessment scales do not predict the quality of anesthetic induction. m-YPAS scale can detect increasing anxiety in children as they approach the surgical procedure and this correlates strongly with a worse anesthetic induction, defined by higher score on ICC scale.
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Affiliation(s)
- Alberto Vieco-García
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría (6° planta sur), Hospital Clínico San Carlos, C/Profesor Martin Lagos s/n, 28040, Madrid, Spain.,Departamento de Pediatría y Neuropediatría, Clínica Universidad de Navarra, Campus Madrid, Madrid, Spain
| | - Amanda López-Picado
- Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Facultad de Salud, Universidad Internacional de La Rioja, Logroño, Spain
| | - Manuel Fuentes
- Unidad de apoyo metodológico a la Investigación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Laura Francisco-González
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría (6° planta sur), Hospital Clínico San Carlos, C/Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Belén Joyanes
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría (6° planta sur), Hospital Clínico San Carlos, C/Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Carmen Soto
- Cirugía Pediátrica, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Garcia de la Aldea
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría (6° planta sur), Hospital Clínico San Carlos, C/Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | | | - Esther Aleo
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría (6° planta sur), Hospital Clínico San Carlos, C/Profesor Martin Lagos s/n, 28040, Madrid, Spain. .,Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Jerez-Molina C, Lázaro-Alcay JJ, Ullán-de la Fuente AM. Transcultural adaptation into Spanish of the Induction Compliance Checklist for assessing children's behaviour during induction of anaesthesia. ENFERMERIA CLINICA 2017; 28:S1130-8621(17)30142-0. [PMID: 29054560 DOI: 10.1016/j.enfcli.2017.08.006] [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: 12/09/2015] [Revised: 07/26/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Cross-cultural adaptation into Spanish of the Induction Compliance Checklist (ICC) for assessing children's behaviour during induction of anaesthesia. METHOD A descriptive cross-sectional observational study was conducted on a sample of 81 children aged 2 to 12 years operated in an ambulatory surgery unit of a paediatric hospital in Barcelona. Adaptation by translation-back translation of the tool and analysis of the scale's validity and reliability. RESULTS Face validity of the tool was guaranteed through a discussion group and inter-observer reliability was evaluated, obtaining an intraclass correlation index of r = 0.956. CONCLUSIONS The ICC scale validated for the Spanish population can be an effective tool for the presurgical evaluation of activities carried out to minimise children's anxiety. The ICC is an easy-to-use scale completed by operating room staff in one minute and would provide important information about children's behaviour, specifically during induction.
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Affiliation(s)
- Carmen Jerez-Molina
- Departamento de Enfermería, Unidad de Cirugía Ambulatoria, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España.
| | - Juan J Lázaro-Alcay
- Departamento de Anestesiología y Reanimación, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España
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