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Cai YH, Wang CY, Fang YB, Ma HY, Gao YQ, Wang Z, Wu J, Lin H, Liu HC. Preoperative Anxiolytic and Sedative Effects of Intranasal Remimazolam and Dexmedetomidine: A Randomized Controlled Clinical Study in Children Undergoing General Surgeries. Drug Des Devel Ther 2024; 18:1613-1625. [PMID: 38774484 PMCID: PMC11108072 DOI: 10.2147/dddt.s461122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/11/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose Remimazolam, an ultra-short-acting and fast-metabolized sedative, has only been sporadically investigated in children. This study was performed to determine the beneficial effects of intranasal remimazolam or dexmedetomidine on preoperative anxiety in children undergoing general surgeries. Patients and Methods Ninety children were randomly and equally assigned to Group R (intranasal remimazolam 1.5mg kg-1), Group D (intranasal dexmedetomidine 2 mcg kg-1), and Group C (intranasal distilled water). The primary outcomes were the preoperative anxiety scores using the modified Yale preoperative anxiety scale (m-Ypas). The secondary outcomes included the cooperation behaviour of intranasal drug application, preoperative sedation levels, parental separation anxiety scores (PSAS), and mask acceptance scores (MAS). Results Group R showed a significant low anxiety at 10 min after intranasal premedication (vs group C, P=0.010; vs group D, P = 0.002) and at anaesthesia induction (vs group C, P = 0.004). Group D showed a significantly low anxiety score only prior to anaesthesia induction (vs group C, P = 0.005). Most children in group R achieved mild sedation at 10 min (vs group C, P < 0.001; vs group D, P < 0.001), with a few progressing to deep sedation afterwards, while group D tended toward deep sedation. Compared to Group C, patients in Group R performed significantly better on the MAS (P = 0.014) and PSAS (P = 0.008). However, remimazolam did cause poor cooperation behavior to the intranasal application due to its mucosal irritation (vs group C, P = 0.001; vs group D, P = 0.010). Conclusion Both intranasal remimazolam and dexmedetomidine can effectively alleviate preoperative anxiety in children. While intranasal remimazolam has a rapid onset, it produces only mild sedation and causes substantial nasal irritation. Trial Registration NCT04720963, January 22, 2021, ClinicalTrials.Gov.
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Affiliation(s)
- Yu-Hang Cai
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Cheng-Yu Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yu-Bo Fang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Hong-Yu Ma
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yu-Qing Gao
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Zhen Wang
- Laboratory Medicine Center, Allergy Center, Department of Transfusion Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Junzheng Wu
- Department of Anesthesiology, Cincinnati Children’s Hospital, Cincinnati, OH, 45229, USA
| | - Han Lin
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Hua-Cheng Liu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University; Key Laboratory of Pediatric Anesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
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López-Fernández E, Palacios-Cuesta A, Rodríguez-Martínez A, Olmedilla-Jodar M, Fernández-Andrade R, Mediavilla-Fernández R, Sánchez-Díaz JI, Máximo-Bocanegra N. Implementation feasibility of animal-assisted therapy in a pediatric intensive care unit: effectiveness on reduction of pain, fear, and anxiety. Eur J Pediatr 2024; 183:843-851. [PMID: 37938352 PMCID: PMC10912116 DOI: 10.1007/s00431-023-05284-7] [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] [Received: 07/18/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023]
Abstract
Animal-assisted therapies are an innovative strategy within health care humanization initiatives, and they could play a role in the reduction of pain or anxiety. The main objective of this work was to evaluate the feasibility of implementing animal-assisted therapy in a pediatric intensive care unit and its effectiveness for the reduction of pain, fear, and anxiety. A prospective, quasi-experimental study of animal-assisted therapy was designed in the pediatric intensive care unit of the Hospital Universitario 12 de Octubre of Madrid, from January 2019 to December 2019. The study sample included patients who had been admitted to the unit and were over 3 years old. Satisfaction surveys were collected from the patients, family, and health personnel involved. Physiological variables and the level of pain (visual analog scale or Wong-Baker scale), fear (Child Medical Fear Scale), and anxiety (modified Yale Preoperatory Anxiety Scale) were evaluated before and after each session. Any existence of adverse events was recorded. A total of 74 therapy sessions were performed on 61 patients. All sessions were completed without any adverse effects. A total of 164 surveys were collected, providing an overall project rating of 9.69 out of a possible 10. The survey comments were found to be positive in most cases. No differences were found in the physiological variables measured before and after each session. There was a statistically significant decrease in pain, fear, and anxiety levels (p < 0.01). Conclusion: The implementation of an animal-assisted therapy project in a pediatric intensive care unit is feasible and safe and has a high degree of acceptance among both participants and healthcare staff. Animal-assisted therapy is effective for the reduction of pain, fear, and anxiety, and therefore, it could be considered an adjunct to non-pharmacological therapy. What is Known: • Animal assisted therapies (AAT) are an innovative strategy that could be beneficial to help pediatrics patients cope with admission difficulties and could even play a role in reducing pain, anxiety and/or delirium. • To date there are not studies to analyze the effectiveness of AAT in the field of Pediatric Intesive Care. What is New: • Our study confirms the feasibility and effectiveness of the implementation of an AAT in the field of Pediatric Intensive Care with a high degree of acceptance by participants, caregivers and healthcare personnel. • AAT demonstrated a reduction in pain, fear and anxiety in pediatrics patients admitted to Pediatric Intensive Care Unit.
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Affiliation(s)
| | | | | | | | | | | | | | - Nuria Máximo-Bocanegra
- Animals and Society Chair Program, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
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Aggarwal P, Mathur S, Chopra R. Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator. Int J Clin Pediatr Dent 2024; 17:59-66. [PMID: 38559870 PMCID: PMC10978511 DOI: 10.5005/jp-journals-10005-2758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Aim To investigate the potential effectiveness of "medical clowns" on preoperative, intraoperative, and postoperative anxiety of children undergoing various dental treatments and also its effect on the operator's stress levels in a dental setup. Materials and methods A total of 170 pediatric patients, aged 4-8 years, indicated for preventive therapy, extractions, restorative, and endodontics were included and divided into two groups [group I-audiovisual (A-V) aids; group II-medical clowns], group of 85 patients each after recording Modified yale preoperative scale. Both pre- and postoperatively, Frankl's behavior score was recorded for each patient. During treatment, the face, legs, activity, cry, consolability (FLACC) pain scale, and dental operator's stress level were recorded. Results Intervention of medical clowns positively influenced children during dental treatment by increasing their pain threshold. The majority of children showed positive Frankl rating scales after dental treatment. Also, the operator's stress was significantly reduced, which led to enhanced treatment outcomes. Conclusion Humor yields the power of healing, distracts pediatric patients, reduces their anxiety, and alleviates their pain, conferring the patients with a sense of laughter, creativity, and care.Therefore, medical clowns in pediatric dentistry can prove to be serviceable and valuable as a nonpharmacological approach to behavior management. How to cite this article Aggarwal P, Mathur S, Chopra R. Assessment of Medical Clowning in Influencing the Anxiety and Behavior Scores of Children Undergoing Various Dental Treatments and the Stress Levels of the Operator. Int J Clin Pediatr Dent 2024;17(1):59-66.
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Affiliation(s)
- Priyanka Aggarwal
- Department of Pediatric and Preventive Dentistry, ITS Dental College Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Shivani Mathur
- Department of Pediatric and Preventive Dentistry, ITS Dental College Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Radhika Chopra
- Department of Pediatric and Preventive Dentistry, ITS Dental College Muradnagar, Ghaziabad, Uttar Pradesh, India
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Martins Mesquita E. A Short Guide on How to Carry Out Validation of Scales Measuring Health Outcomes. ACTA MEDICA PORT 2023; 36:695-697. [PMID: 37224562 DOI: 10.20344/amp.20041] [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: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Edgar Martins Mesquita
- EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto; Laboratory for Integrative and Translational Research in Population Health (ITR). Instituto de Saúde Pública. Universidade do Porto. Porto. Portugal
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Long X, Wen LX, Yang H, Zhu GH, Zhang QY, Jiang JJ, Gong Y. ED 95 of remimazolam in nasal administration for attenuating preoperative anxiety in children. Front Med (Lausanne) 2023; 10:1253738. [PMID: 37680615 PMCID: PMC10482406 DOI: 10.3389/fmed.2023.1253738] [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: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
Background Preoperative anxiety often prevails in children at higher levels than adults, which is a common impediment for surgeons and anesthesiologists. It is of great necessity to explore an appropriate medication to improve this situation. Remimazolam, a type of benzodiazepine drug, has been indicated for the induction and maintenance of procedural sedation in adults since 2020. To date, rare studies were reported to investigate the effect of remimazolam on children. In this study, we investigated the safety and efficacy of intranasal drops of remimazolam and tried to determine the 95% effective dose (ED95) of remimazolam in single intranasal administration in attenuating preoperative anxiety in children. Methods In this study, 114 children were enrolled who underwent laparoscopic high-level inguinal hernia ligation between January 2021 and December 2022 and were divided into an early childhood children group and a pre-school children group. The biased coin design (BCD) was used to determine the target doses. A positive response was defined as the effective relief of preoperative anxiety (modified Yale Preoperative Anxiety Scale, mYPAS < 30). The initial nasal dose of remimazolam was 0.5 mg·kg-1 in the two groups. An increment or decrement of 0.1 mg·kg-1 was applied depending on the sedative responses. Isotonic regression and bootstrapping methods were used to calculate the ED95 and 95% confidence intervals (CIs), respectively. Results A total of 80 children completed the study, including 40 in the early childhood group and 40 in the pre-school children group. As statistical analysis indicated, the ED95 of a single intranasal infusion of remimazolam for the relief of preoperative anxiety is 1.57 mg·kg-1 (95% CI: 1.45-1.59 mg·kg-1) in early childhood children and 1.09 mg·kg-1 (95% CI: 0.99-1.11 mg·kg-1) in pre-school children, and the CIs did not overlap each other. Conclusion Remimazolam is an effective medication to relieve preoperative anxiety in children. Moreover, the ED95 of single nasal administration of remimazolam for effective relief of preoperative anxiety was 1.57 and 1.09 mg·kg-1 in early childhood children and pre-school children, respectively.
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Affiliation(s)
| | | | | | | | | | | | - Yuan Gong
- Institute of Anesthesiology and Critical Care Medicine, Yichang Central People's Hospital, China Three Gorges University, Yichang, China
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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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Dobrina R, Cassone A, Dal Cin M, Ronfani L, Giangreco M, Schreiber S, Zanchiello S, Starec A, Brunelli L, Brumatti LV, Bicego L. Study protocol for a randomised controlled trial to determine the effectiveness of a mHealth application as a family supportive tool in paediatric otolaryngology perioperative process (TONAPP). Trials 2023; 24:355. [PMID: 37231477 DOI: 10.1186/s13063-023-07376-z] [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: 12/14/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Otorhinolaryngology (ORL) surgery is common in children, but hospitalisation, surgery, and home care after discharge are stressful experiences for young patients and their family caregivers. Findings from literature highlight a lack of time in hospitals to support ORL surgery children and their caregivers through the perioperative process, along with the risks of caregivers' autonomous web or social media resources investigation. Therefore, this study aims to evaluate the effectiveness of a mobile health application with content to support ORL patients and their caregivers in the perioperative period to reduce caregiver anxiety and child distress compared to standard care. METHODS An open-label, two-arm randomised control trial design is being adopted. The intervention consists of a mobile health application with content to support ORL patients and their caregivers during the perioperative period. One hundred eighty participants will be enrolled and randomly assigned to the experimental group using the mHealth application or the control group. The control group receives standard information and education about the ORL perioperative period from healthcare providers orally or through brochures. The primary outcome is the difference between the intervention and control groups in preoperative caregiver state anxiety. Secondary outcome measures include children's distress before surgery and family preparation for hospitalisation. DISCUSSION The results of this study will be critical to the implementation of a new and safe model for the management of care and education in paediatrics. This model can achieve positive organisational and health outcomes by supporting continuity of care and empowering citizens to have informed participation and satisfaction in paediatric health promotion and management. TRIAL REGISTRATION Trial identifier: NCT05460689 registry name: ClinicalTrials.gov. Date of registration: July 15, 2022. Last update posted: February 23, 2023.
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Affiliation(s)
- Raffaella Dobrina
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
| | - Andrea Cassone
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Margherita Dal Cin
- Department of Health Prevention, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Silvana Schreiber
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Laura Brunelli
- Healthcare Professions Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Liza Vecchi Brumatti
- Scientific Direction, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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Yun R, Hess O, Kennedy K, Stricker PA, Blake L, Caruso TJ. Assessing pediatric perioperative affect: A concise review of research and clinically relevant scales. Paediatr Anaesth 2023; 33:243-249. [PMID: 36178764 DOI: 10.1111/pan.14568] [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: 02/23/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 02/07/2023]
Abstract
Perioperative anxiety and distress are common in pediatric patients undergoing general anesthesia and increase the risk for immediate and long-term postoperative complications. This concise review outlines key research and clinically-relevant scales that measure pediatric perioperative affect. Strengths and weaknesses of each scale are highlighted. A literature review identified 11 articles with the following inclusion criteria: patients less than or equal to 18 years, perioperative anxiety or distress, and original studies with reliability or validity data. Although robust research-based assessment tools to measure anxiety have been developed, such as the Modified Yale Preoperative Anxiety Scale, they are too complex and time-consuming to complete by clinicians also providing anesthesia. Clinically-based anxiety measurement scales tend to be easier to use, however they require further testing before widespread standard utilization. The HRAD ± scale (Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation) may be a promising observational anxiety scale that is efficient and includes an assessment of compliance. Further studies are needed to refine a clinically-relevant anxiety assessment tool and appraise interventions that reduce perioperative distress.
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Affiliation(s)
- Romy Yun
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, California, USA
| | - Olivia Hess
- Stanford School of Medicine, Stanford, California, USA
| | | | - Paul A Stricker
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lindsay Blake
- University of Arkansas for Medical Sciences Library, Little Rock, Arkansas, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, California, USA
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Chen YYK, Soens MA, Kovacheva VP. Less stress, better success: a scoping review on the effects of anxiety on anesthetic and analgesic consumption. J Anesth 2022; 36:532-553. [PMID: 35779126 DOI: 10.1007/s00540-022-03081-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
Preoperative anxiety has an incidence of 11-80% in patients undergoing surgical or interventional procedures. Understanding the role of preoperative anxiety on intraoperative anesthetic requirements and postoperative analgesic consumption would allow personalized anesthesia care. Over- or under-anesthetizing patients can lead to complications such as postoperative cognitive dysfunction in elderly patients, or procedural discomfort, respectively. Our scoping review focuses on the current evidence regarding the association between preoperative anxiety and intraoperative anesthetic and/or postoperative analgesic consumption in patients undergoing elective surgical or interventional procedures. Based on 44 studies that met the inclusion criteria, we found that preoperative anxiety has a significant positive correlation effect on intraoperative propofol and postoperative opioid consumption. The analysis of the literature is limited by the heterogeneity of preoperative anxiety tools used, study designs, data analyses, and outcomes. The use of shorter, validated preoperative anxiety assessment tools may help optimize the intraoperative anesthetic and postoperative analgesic regimen. Further research to determine the most feasible and clinically relevant preoperative anxiety tool and subsequent implementation has the potential to optimize perioperative care and improve patient outcomes.
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Affiliation(s)
- Yun-Yun K Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, L1,, Boston, MA, 02115, United States of America
| | - Mieke A Soens
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, L1,, Boston, MA, 02115, United States of America
| | - Vesela P Kovacheva
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, L1,, Boston, MA, 02115, United States of America.
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Cristoforo T, Gonzalez D, Bender M, Uy G, Papa L, Ben Khallouq BA, Clark M, Carr B, Cramm K. A Pilot Study Testing Intranasal Ketamine for the Treatment of Procedural Anxiety in Children Undergoing Laceration Repair. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:479-486. [PMID: 35600518 PMCID: PMC9120296 DOI: 10.1007/s40653-021-00402-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 06/03/2023]
Abstract
Identifying non-invasive methods for anxiolysis is becoming increasingly important in the pediatric emergency department (ED). Few studies have examined the use of intranasal (IN) ketamine for procedural anxiolysis. We aim to evaluate if IN ketamine provides satisfactory anxiolysis for patients undergoing laceration repair based on anxiety and sedation scoring. We also evaluated the feasibility of using IN ketamine in future trials based on its tolerability and side-effects. A pilot study evaluating IN ketamine in the treatment of procedural anxiety for patients, 2 years and older, weighing 40 kg or less, presenting to the pediatric ED with lacerations. The need for anxiolysis was defined by an elevated modified-Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) score. Patients received 5 mg/kg of IN ketamine in addition to topical anesthesia, mYPAS-SF scoring before and during the procedure, sedation scoring, adverse events, vital signs, age, weight, laceration size and location, and satisfaction surveys were recorded. Twenty-five patients were enrolled, with mean age of 61 ± 29.2 months and mean weight of 21 ± 6.4 kg. Lacerations were located on the face, extremities, and groin with mean size of 2.1 cm. A decrease in anxiety levels was observed, from median m-YPAS-SF score of 66.7 (62.50-80.2) to 33.3 (27.09-52.00), p < 0.001. Among the patients, 92% (n = 23) were less anxious during the procedure. IN ketamine appears to be safe and well-tolerated with a positive impact on procedural anxiety. A dosage of 5 mg/kg is a reasonable starting point, as 80% of patients had appropriate anxiolysis.
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Affiliation(s)
- Thomas Cristoforo
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
| | - Dulce Gonzalez
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
| | - Mark Bender
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Geraldine Uy
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Linda Papa
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Bertha A. Ben Khallouq
- Research Department, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL USA
| | - Mark Clark
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
- Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL USA
| | - Brandon Carr
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
| | - Kelly Cramm
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL USA
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Correale C, Borgi M, Collacchi B, Falamesca C, Gentile S, Vigevano F, Cappelletti S, Cirulli F. Improving the Emotional Distress and the Experience of Hospitalization in Children and Adolescent Patients Through Animal Assisted Interventions: A Systematic Review. Front Psychol 2022; 13:840107. [PMID: 35317013 PMCID: PMC8934415 DOI: 10.3389/fpsyg.2022.840107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Animal Assisted Interventions (AAIs) are increasingly common in pediatric care settings as a means to promote the physical, mental, and emotional well-being of hospitalized children and adolescents. Objectives The aim of this work was to review published studies implementing AAIs in hospital settings and to assess the effects of AAIs on the biobehavioral response to stress and pain, social behavior, quality of life and level of satisfaction with hospitalization in children and adolescents. Stress and burden, quality of life, mood and level of satisfaction with hospitalization in parents/caregivers as well as stress and burden, perception of the work environment and job satisfaction in hospital staff were also reviewed. Methods All published studies reporting quantitative assessments were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The aim was to identify studies examining the effects of AAIs on behavioral, psychological and physiological responses to stress in children and adolescents (0-18 years) formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations. Results Of the 350 studies screened, 21 were eligible for inclusion. Most of them focused on stress, pain, and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral and psychological observations/scales. All studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients while acting on physiological measures associated with arousal. Conclusion Although further, more rigorous studies are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178993], identifier [CRD42020178993].
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Affiliation(s)
- Cinzia Correale
- Clinical Psychology Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marta Borgi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Barbara Collacchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Falamesca
- Clinical Psychology Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Federico Vigevano
- Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Simona Cappelletti
- Clinical Psychology Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
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Hekimoglu Sahin S, Duran R, Basaran UN, Sut N, Colak A, Duran S. Is music the food of the anesthesia in children? WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000328. [DOI: 10.1136/wjps-2021-000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundThe noise in an operating room may have a detrimental effect on human cognitive functions, and it may cause perioperative anxiety with prolonged exposure. The aim of this study was to investigate the effects of music therapy and use of earplugs and normal noise level in the operating room under general anesthesia of pediatric patients on hemodynamic parameters and postoperative emergence delirium.MethodsOne hundred and five pediatric patients were involved in this study. The patients were randomly divided into three groups. Group N was exposed to the ambient operating room noise, group S received earplugs from an independent anesthesiologist, and group M used a CD player. The preoperative anxiety levels of children were evaluated with the Modified Yale Preoperative Anxiety Scale (M-YPAS). Mean arterial pressure (MAP) and heart rate were recorded at 30-minute periods until the completion of surgery, end of surgery and postoperatively. During each measurement, noise level recordings were performed using sonometer. Pediatric Anesthesia Emergency Delirium (PAED) score was evaluated after postoperative extubation.ResultsM-YPAS was similar between groups. The MAP at 30 and 60 min intraoperatively, at end of surgery, and at 5, 10, and 15 min postoperatively was significantly lower in group S than in group N. There were no differences in heart rate among the groups. Postoperative PAED score was not significantly different among the groups.ConclusionsThe music therapy was not more effective than silence and operating noise room in reducing PAED score postoperatively in pediatric patients.Trial registration numberClinicalTrials.gov Registry (NCT03544502).
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13
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Yang Y, Zhang M, Sun Y, Peng Z, Zheng X, Zheng J. Effects of advance exposure to an animated surgery-related picture book on preoperative anxiety and anesthesia induction in preschool children: a randomized controlled trial. BMC Pediatr 2022; 22:92. [PMID: 35164741 PMCID: PMC8843029 DOI: 10.1186/s12887-022-03136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to investigate whether early surgical preparation by reading an animated picture book about procedure-related events could reduce the preoperative anxiety in preschoolers. METHODS 131 patients, aged 3-6 years and underwent elective minor surgery were randomized either to a control or a picture book group. Both groups received general information about surgery and anesthesia in pre-anesthesia clinic. Patients in study group also received a surgery-depicting picture book for them to read at home a week earlier before surgery. Child anxiety was evaluated with the modified Yale Preoperative Anxiety Scale Short Form in six observing time points before anesthesia induction, and the compliance of anesthesia induction was assessed with the Induction Compliance Checklist (ICC). RESULTS There were significantly lower anxiety scores in picture book group than in control group at the time of ready for intravenous cannulation in operating room [51.9 (23.6) vs. 67.2 (22.0); mean difference 15.3; 95% confidence interval (CI) 6.4-24.1; P = 0.001] and at the time of pre-anesthesia visit [27.8 (7.6) vs. 33.2 (13.6); mean difference 5.3; 95%CI 0.93-9.8; P = 0.018]. No significant differences of anxiety levels were found between two groups at other observed time points: in the anesthesia outpatient clinic, in the holding area, at separation from parent to operating room (OR), and on entrance to OR (P = 0.584, 0.335, 0.228, 0.137, respectively). The percentage of children with poor induction compliance (i.e., ICC ≥ 6) was higher in control group compared with that in picture book group [38% vs.21%; odds ratio(95%CI): 0.78(0.61-0.99); P = 0.041]. CONCLUSIONS Home-reading an animated picture book to get familiar with the perioperative events earlier prior to surgery could effectively reduce the preoperative anxiety level and increase the compliance during the induction of anesthesia in preschool children. TRIAL REGISTRATION ChiCTR2000033583, 06/06/2020 www.chictr.org.cn .
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Affiliation(s)
- Yanyan Yang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mazhong Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Zhezhe Peng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaosu Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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14
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Wu L, Xiang X, Guo H, Tan H. The effect of non-pharmacological interventions on psychological stress and quality of life of parents of children with retinoblastoma: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28148. [PMID: 34941063 PMCID: PMC8702223 DOI: 10.1097/md.0000000000028148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Retinoblastoma is the most common malignant tumor in infancy and early childhood. Due to the high incidences of intracranial metastasis and distant metastasis, retinoblastoma not only threatens the life of affected children, but also brings heavy mental stress to their parents. A strong mental stress often leads to anxiety, depression, and other adverse emotions, which is very unfavorable to the treatment and prognosis by generating great psychological pressure and reducing the quality of life of the family. Reducing the psychological stress of the parents and improving the quality of life of the family are beneficial to the treatment and prognosis of retinoblastoma in children. However, there are no recommended non-pharmacological therapies to reduce the psychological stress and improve the quality of life of the parents of children with retinoblastoma. This study aims to evaluate the effects of non-pharmacological therapies on psychological stress and quality of life of parents of children with retinoblastoma through a meta-analysis, thus providing clinical evidence. METHODS Randomized controlled trials reporting the effects of non-pharmacological therapies on psychological stress and quality of life of parents of children with retinoblastoma published before 2021 November will be searched in online databases, including the China National Knowledge Infrastructure, Wanfang, Chinese Scientific Journal Database, China Biomedical Literature Database, PubMed, Embase, The Cochrane Library, and Web of Science databases. The Cochrane Quality Assessment Manual will be used to assess the quality of the included literatures. Meta-analysis will be performed using Revman 5.4 software. RESULTS This study will evaluate the effects of non-pharmacological therapies on psychological stress and quality of life of parents of children with retinoblastoma via grading anxiety scores, depression scores, and quality-of-life scores. CONCLUSION This study will provide a reliable evidence-based basis for non-pharmacological interventions on parents of children with retinoblastoma. ETHICS AND DISSEMINATION Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations.OSF REGISTRATION NUMBER.
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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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16
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Evaluation of the Effect of Hydroxyzine on Preoperative Anxiety and Anesthetic Adequacy in Children: Double Blind Randomized Clinical Trial. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7394042. [PMID: 34805403 PMCID: PMC8601851 DOI: 10.1155/2021/7394042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/19/2021] [Accepted: 10/10/2021] [Indexed: 11/17/2022]
Abstract
Surgical procedures can generate significant preoperative anxiety (POA) in as much as 70% of the paediatric population. The role of hydroxyzine and distractive techniques such as clowns in the management of anxiety is controversial. Our main objective was to evaluate the effect of hydroxyzine on the control of POA. The secondary objective was to assess the potential additive effect of hydroxyzine and distracting techniques. We performed a randomized double-blind, controlled clinical trial in children aged 2–16 years undergoing outpatient surgery (n = 165). Subjects were randomized to hydroxyzine (group 1) or placebo (group 2). For the secondary objective, two further groups were made by allocation by chance to hydroxyzine plus accompaniment with clowns (group 3) and placebo plus clowns (group 4). All patients were accompanied by their parents as the standard procedure. POA was determined by a modified Yale scale of POA (m-YPAS). Compliance of children during induction of anesthesia (Induction Compliance Checklist (ICC)) was also assessed. No differences (p = 0.788) were found in POA control at the time of induction measured by m-YPAS (group 1: 39.2 ± 27.9; group 2: 37.0 ± 26.1; group 3: 34.7 ± 25.5; group 4: 32.4 ± 20.5). No differences were found in the level of ICC between the different treatment arms (group 1: 1.8 ± 3.4; group 2: 1.5 ± 3.0; group 3: 1.2 ± 2.4; group 4: 1.5 ± 2.7). The combination of all treatments (group 3) was the only effective strategy to contain the progression of anxiety. In conclusion, hydroxyzine was not effective to control POA in children. The combination of hydroxyzine and clowns avoided the progression of POA in our patients. This trial is registered with ClinicalTrials.gov identifier: NCT03324828 (registered 21 September 2017, subject recruitment started on 12th January 2018).
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17
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Chu L, Wang Y, Wang S, Su S, Guo Z, Wang G. Intranasal Dexmedetomidine Accompanied by Cartoon Video Preoperation for Reducing Emergence Delirium in Children Undergoing Strabismus Surgery: A Prospective Randomized Trial. Front Surg 2021; 8:754591. [PMID: 34746225 PMCID: PMC8569138 DOI: 10.3389/fsurg.2021.754591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: After general anesthesia, many pediatric patients present with emergence delirium (ED). The aim of this study was to determine whether dexmedetomidine intranasal premedication accompanied by a cartoon video 30 min before general anesthesia would have an effect on reducing emergence delirium in preschool children. Methods: One hundred and forty children aged 3–6 year undergoing elective strabismus surgery were randomly to be premedicated with 2 μg kg−1 intranasal dexmedetomidine accompanied by the viewing of a cartoon video (Group DV) or without any premedication as usual (Group C). The primary outcome was the incidence of emergence delirium at the postanesthesia care unit (PACU), evaluated by the Pediatric Anesthesia Emergence Delirium (PAED) scale. The secondary outcomes included: the Modified Yale Preoperative Anxiety Scale (mYPAS) upon separation from parents; the Induction Compliance Checklist score (ICC); the PACU discharge time; the parental satisfaction score; the incidences of the side effects and the Post-Hospital Behavior Questionnaire (PHBQ) score during the first day after surgery. Results: The incidence of emergence agitation (PAED score ≥ 10) was reduced in Group DV compared with Group C [8 (11.4%) vs. 24 (34.3%); P = 0.001]. None of the patients in the DV group experienced severe emergence agitation (PAED score ≥ 15), as compared with the C group (P = 0.006). The mYPAS score upon separation from parents (P < 0.001) and the incidence of poor coordination (ICC ≥ 4) during induction (P < 0.001) were significantly lower in Group DV than in Group C. In Group DV, the PACU discharge time was longer (P < 0.001), and the parental satisfaction score was higher (P < 0.001). However, during the first day after surgery, the PHBQ score was lower in Group DV compared with Group C (P = 0.001). Conclusions: Premedication with 2 μg kg−1 intranasal dexmedetomidine accompanied by cartoon video viewing can dramatically reduce emergence delirium in preschool children undergoing strabismus surgery, relieve preoperative anxiety and improve the parental satisfaction and the postoperative behavior changes during the first day after surgery. Clinical Trial Registration: ChiCTR2000030678.
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Affiliation(s)
- Liyan Chu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yue Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shanshan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shaofei Su
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zhixing Guo
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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18
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Vogt L, Klasen M, Rossaint R, Goeretz U, Ebus P, Sopka S. Virtual Reality Tour to Reduce Perioperative Anxiety in an Operating Setting Before Anesthesia: Randomized Clinical Trial. J Med Internet Res 2021; 23:e28018. [PMID: 34252034 PMCID: PMC8444035 DOI: 10.2196/28018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perioperative anxiety is a major burden to patients undergoing surgeries with general anesthesia. OBJECTIVE This study investigated whether a virtual operating room tour (VORT) before surgery can be used to ameliorate perioperative anxiety. METHODS We employed a randomized parallel-group design with 2 study arms to compare VORT to the standard operation preparation procedure. The study included 84 patients. A validated inventory (state-trait operation anxiety-state) was used to assess perioperative state anxiety before (T1) and after (T2) surgery. In addition, trait operation anxiety was evaluated with an additional validated inventory (state-trait operation anxiety-trait). Moreover, user ratings on the usefulness of VORT were assessed with an evaluation questionnaire. Study arms were compared for perioperative state anxiety with two-tailed independent samples t tests. Subjective ratings were correlated with STOA-Trait values to investigate possible associations between perioperative anxiety with perceived usefulness. RESULTS There were no significant differences in perioperative state anxiety between VORT and standard operation preparation procedures before and after the surgery. Nonetheless, patients' ratings of VORT overall were positive. The tour was perceived as useful and, therefore, showed acceptance for VR use. These ratings were unrelated to the degree of perioperative anxiety. CONCLUSIONS The subjective benefit of VORT could not be explained by a reduction of perioperative anxiety. Instead, VORT appears to serve the need for information and reduce uncertainty. In addition, VORT is perceived as beneficial regardless of the age of the patients. Considering this effect and the manageable organizational and financial effort toward implementation, the general use of VORT can be recommended. TRIAL REGISTRATION ClinicalTrials.gov NCT04579354; https://clinicaltrials.gov/ct2/show/NCT04579354.
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Affiliation(s)
- Lina Vogt
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Martin Klasen
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
| | - Ute Goeretz
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Peter Ebus
- Faculty of Educational Science, Open University, Heerlen, Netherlands
| | - Sasa Sopka
- AIXTRA Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany
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Liang Y, Huang W, Hu X, Jiang M, Liu T, Yue H, Li X. Preoperative anxiety in children aged 2-7 years old: a cross-sectional analysis of the associated risk factors. Transl Pediatr 2021; 10:2024-2034. [PMID: 34584872 PMCID: PMC8429856 DOI: 10.21037/tp-21-215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Preoperative anxiety in children is harmful. Despite this, there is a scarcity of studies examining the incidence of preoperative anxiety and its related effects in China. This study investigated preoperative anxiety in children aged 2 to 7 in the pediatric surgery department of a tertiary hospital in China. The factors influencing preoperative anxiety in these children were identified. METHODS The researchers used the Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS) and the Short Form of CmYPAS (CmYPAS-SF) to assess the preoperative anxiety state of children aged 2 to 7 who underwent elective surgery in the pediatric department of a tertiary hospital in China from July 1, 2020 to September 30, 2020 were enrolled in this study. The generalized estimating equation model was used to analyze the factors influencing preoperative anxiety in children. RESULTS The preoperative anxiety rate of 220 children in the tertiary hospital was 67.6%. Multivariate analysis revealed that children who attended elementary school had a lower risk of preoperative anxiety compared to children who did not attend school [odd ratio (OR) =0.39, 95% confidence interval (CI), 0.19 to 0.79, P=0.010]. Children whose caregivers felt very worried experienced an increased risk of preoperative anxiety compared to children whose caregivers were not worried about the surgery at all (OR =3.40, 95% CI, 1.35 to 8.56, P=0.009). Children who were very resistant, cried violently, twisted their bodies during puncturing the needle were 5.8 times more likely to experience preoperative anxiety compared to children who were very cooperative. The risk of preoperative anxiety in children who cooperated with a staff member was about 1.5 times higher than that of children who were very cooperative. CONCLUSIONS The incidence of preoperative anxiety in children aged 2 to 7 in the tertiary hospital in China was similar to the children in other countries. The caregivers' degree of concern priored to the operation and the degree of cooperation from the children during puncturing the indwelling needle were the main factors influencing the occurrence of preoperative anxiety.
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Affiliation(s)
- Yuanyuan Liang
- Department of Pediatric Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenjiao Huang
- Department of Pediatric Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Xinyu Hu
- Department of Pediatric Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Meiling Jiang
- Department of Pediatric Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Tian Liu
- Department of Pediatric Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Hong Yue
- Department of Pediatric Surgery, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoling Li
- West China School of Nursing, Sichuan University, Chengdu, China
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Giordano F, Rutigliano C, De Leonardis F, Rana R, Neri D, Brienza N, Santoro N. Covid-19 and absence of music therapy: Impact on mother-child dyad during invasive procedures in pediatric oncology. ARTS IN PSYCHOTHERAPY 2021; 75:101839. [PMID: 34334856 PMCID: PMC8316673 DOI: 10.1016/j.aip.2021.101839] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/07/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
During COVID-19 pandemic, Italian pediatric oncology departments were obliged to adopt restrictive measures to minimize the risk of in-hospital infections in frail patients and staff members. Access to the wards was significantly reduced and music therapy (MT) activities were suspended. The aim of this study was to compare the level of anxiety and sedation in pediatric patients undergoing invasive procedure before (T1), during(T2) and after(T3) the pandemic, with and without the presence of MT. From January to September 2020, all children aged 2–15 with oncological and hematological diseases undergoing to invasive procedure were enrolled. During T1 and T3 children received preoperative preparation with MT by a certified music-therapist. In T2 they received music or video by clinical staff. Preoperative anxiety scores were measured with the m- YPAS scale. Interviews with mothers were performed. The average consumption of drugs used was analyzed. Significant differences in preoperative anxiety levels between scores in T1, T2 (p.value = 0,0000014) and in T2, T3 (p.value = 0,0000031) were observed. No difference between T1-T3 (p.value = 0,96). Higher dosage of midazolam in T2 (1,14 mg 0,189) compared to T1 (0, 71 mg 0,399) and T2 (1,14 mg 0,189) were observed. Mothers also recorded higher scores on anxiety and stress without music therapy.
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Affiliation(s)
- Filippo Giordano
- University of Bari, School of Medicine, Section of Pediatric Hemathology-Oncology, University Hospital of Bari, Italy.,Section of Pediatric Hemathology-Oncology, University Hospital of Bari, Italy
| | - Chiara Rutigliano
- Section of Pediatric Hemathology-Oncology, University Hospital of Bari, Italy
| | | | - Roberta Rana
- Section of Pediatric Hemathology-Oncology, University Hospital of Bari, Italy
| | - Daniela Neri
- Section of Anesthesia and Intensive Care Unit, University Hospital of Bari, Italy
| | - Nicola Brienza
- University of Bari, Section of Anesthesia and Intensive Care Unit, Department of Interdisciplinary Medicine, Italy
| | - Nicola Santoro
- Section of Pediatric Hemathology-Oncology, University Hospital of Bari, Italy
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Alqudimat M, Mesaroli G, Lalloo C, Stinson J, Matava C. State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:265-274. [PMID: 34276254 PMCID: PMC8277426 DOI: 10.1007/s40140-021-00472-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
Purpose of Review This review summarizes and provides a comprehensive narrative synthesis of the current evidence on immersive technology’s (i.e., virtual and augmented Reality) use for perioperative anxiety, acute, and chronic pain in pediatrics. Recent Findings Researchers have increasingly studied immersive technology as a non-pharmacological alternative for perioperative anxiety, acute, and chronic pain management. We found several research studies published over the last 3 years: almost all studies examined the use of virtual reality for perioperative anxiety and pain; only one case report was about the use of augmented reality for preoperative anxiety. Most studies showed that virtual reality intervention is effective and safe for perioperative anxiety, acute, and chronic pain. However, the studies are heterogeneous with relatively small sample sizes. Summary This review shows that more high-quality studies (i.e., randomized controlled trials with larger sample sizes and standardized methods for measuring and reporting outcomes) are needed to examine the effectiveness and adverse effects of virtual reality intervention on perioperative anxiety, acute, and chronic pain in pediatrics.
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Affiliation(s)
- Mohammad Alqudimat
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada.,Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Giulia Mesaroli
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada.,Department of Rehabilitation Services, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Chitra Lalloo
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada.,Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada.,Temerty Faculty of Medicine, Department of Anesthesiology and Pain Medicine, University of Toronto, 123 Edwards Road, Toronto, ON M5G 1E2 Canada
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22
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Du Z, Wei S, Zhang X, Xiang Z, Qu S. The effect of dexmedetomidine premedication on postoperative systemic inflammatory response in children undergoing hernia repair surgery: A randomized controlled trial. Paediatr Anaesth 2021; 31:794-801. [PMID: 33825304 PMCID: PMC8251734 DOI: 10.1111/pan.14189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgery results in systemic inflammation, which can affect the central nervous system, leading to changes in mood, emotion, and behavior. Our previous study has shown that compared to midazolam, dexmedetomidine premedication effectively decreased children's postoperative anxiety. AIM To investigate whether dexmedetomidine infusion before hernia repair alleviates postoperative systemic inflammation in children and whether postoperative anxiety may be associated with postoperative inflammation. METHODS This prospective double-blind randomized controlled trial was conducted in 120 children scheduled to undergo elective hernia repair. Before anesthesia induction, all children received an intravenous infusion consisted of dexmedetomidine (n = 40; 0.5 µg/g, group D), midazolam (n = 40; 0.08 mg/kg, group M), or normal saline (n = 40; group C). One-way ANOVA with least significant difference multiple comparison test was used for multigroup comparisons of postoperative plasma levels of inflammatory cytokines and m-YPAS scores. Spearman rank correlation tests were used for analyzing m-YPAS scores with postoperative plasma levels of inflammatory cytokines. RESULTS Plasma levels of tumor necrosis factor-alpha (7.0 ± 1.6 vs. 8.1 ± 1.6, mean difference [95% CI]: 1.19 [0.26-2.11], p = .008) (pg/ml) and of interleukin-6 (1.8 ± 1.2 vs. 3.3 ± 1.6, mean difference [95% CI]: 1.49 [0.74-2.25], p < .001) (pg/ml) and neutrophils-to-lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.7, mean difference [95% CI]: 0.48 [0.17-0.78], p < .001) were significantly lower in group D than in group C. Furthermore, compared to group M, group D showed significantly lower plasma tumor necrosis factor-alpha levels (7.0 ± 1.6 vs. 7.9 ± 1.9, mean difference [95% CI]: 0.96 [0.04-1.88], p = .04) (pg/ml) and interleukin-6 levels (1.8 ± 1.2 vs. 2.9 ± 1.5, mean difference [95% CI]: 1.06 [0.31-1.81], p = .004) (pg/ml), and neutrophil-to-lymphocyte ratio (1.0 ± 0.5 vs. 1.5 ± 0.6, mean difference [95% CI]: 0.42 [0.11-0.72], p = .004). Anxiety scores at postoperative 2 and 4 h in the three groups positively correlated with plasma levels of proinflammatory cytokines. CONCLUSION A single preoperative intravenous dexmedetomidine dose in children undergoing same-day surgery reduces postoperative systemic inflammation.
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Affiliation(s)
- Zhen Du
- Department of AnesthesiologyHunan Children’ HospitalChangshaChina
| | - Si‐Wei Wei
- Department of AnesthesiologyHunan Children’ HospitalChangshaChina
| | - Xi‐Ying Zhang
- Department of AnesthesiologyHunan Children’ HospitalChangshaChina
| | - Zhen Xiang
- Department of AnesthesiologyHunan Children’ HospitalChangshaChina
| | - Shuang‐Quan Qu
- Department of AnesthesiologyHunan Children’ HospitalChangshaChina
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Zainal Abidin H, Omar SC, Mazlan MZ, Hassan MH, Isa R, Ali S, Hassan SK, Marzuki A. Postoperative Maladaptive Behavior, Preoperative Anxiety and Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review. Glob Pediatr Health 2021; 8:2333794X211007975. [PMID: 33889680 PMCID: PMC8040608 DOI: 10.1177/2333794x211007975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Huda Zainal Abidin
- Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
| | - Sanihah Che Omar
- Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Zulfakar Mazlan
- Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Hasyizan Hassan
- Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
| | - Ruwaida Isa
- Hospital Raja Perempuan Zainab 2, Kota Bharu, Kelantan, Malaysia
| | - Saedah Ali
- Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
| | | | - Ariffin Marzuki
- Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia
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24
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Bay C, Henriquez R, Villarroel L, Gana JC. Effect of music on pediatric endoscopic examinations: a randomized controlled trial. Endosc Int Open 2021; 9:E599-E605. [PMID: 33869733 PMCID: PMC8043808 DOI: 10.1055/a-1352-3244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background and study aims The primary objective was to measure the effect of music as an adjunct to sedation in patient anxiety levels during pediatric endoscopic examinations. Patients and methods We performed a single-blind randomized controlled trial comparing music with no music in children aged 2 to 18 years. Anxiety was measured using the Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Visual Analog Anxiety Scale (VAS-anxiety). Patient perception of pain was evaluated with the Wong-Baker Faces Pain Rating Scale (WBFPRS). Patient experience, family satisfaction, and endoscopist perception of difficulty were evaluated. Sedative doses were recorded. Results A total of 51 children were randomized to the experimental group and 49 children to the control group. The mean ages were 10.5 years and 12.3 years, respectively. There were 63 % female subjects with no differences between groups. Overall, there were 85 upper endoscopies and 15 colonoscopies. In the recovery unit, the experimental group had lower average m-YPAS scores (mean score 27.7 vs 34.7; P < 0.001), a higher proportion of them had low m-YPAS scores (80 % vs 49 % P < 0.001), had lower VAS-anxiety scores [mean score 0.55 vs 1.57 ( P = 0.003)], and had lower WBFPRS scores [mean score 2.7 vs 1.3 ( P = 0.001)]. There were no statistically significant differences found in the amount of standard sedation given to the groups, nor in additional sedation administered. In the experimental group, the patient-reported experience was significantly better. Conclusions The study results show that music reduces anxiety and pain associated with endoscopic procedures in children. It also facilitates these procedures and improves patient satisfaction.
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Affiliation(s)
- Constanza Bay
- Department of Pediatrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Romina Henriquez
- Endoscopy Unit, Center of Medical Specialties, Red de Salud UC Christus, Chile
| | - Luis Villarroel
- Department of Public Health, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Juan Cristóbal Gana
- Department of Gastroenterology and Nutrition, Division of Pediatrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
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Scarano F, Dalla Corte A, Michielon R, Gava A, Midrio P. Application of a non-pharmacological technique in addition to the pharmacological protocol for the management of children's preoperative anxiety: A 10 years' experience. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 43. [PMID: 33739059 DOI: 10.4081/pmc.2021.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to investigate how Non- Pharmacological Techniques (NPT), in addition to standard pharmacological techniques, can help to manage and reduce the preoperative anxiety of children waiting for Day Surgery procedures (DS). Isola Serena activity started in 2008 to manage the preoperative time of children waiting for surgery in the playing room. The latter is run by a pedagogist. NPT includes use of games and toys, readings and drawings. A descriptive and comparative study was conducted on 50 children, aged 4 to 12 years, randomly assigned to Isola Serena group ISG and control group CG. All children received standard pharmacological techniques, while those of the ISG also received the NPT. The evaluation of the preoperative anxiety level (modified Yale Preoperative Anxiety Scale) and parent's coping style (Coping Inventory for Stressful Situation) compared the two groups. The ISG showed a significantly lower level of preoperative anxiety than the CG. Parents' coping style was not related to the preoperative anxiety. The activity performed in the Isola Serena Project resulted to be effective for the reduction of preoperative anxiety in children undergoing DS procedures.
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Affiliation(s)
- Francesca Scarano
- Comitato Assistenza Bambini of the Lega Italiana per la Lotta contro i Tumori (CAB LILT), Treviso.
| | - Alessandra Dalla Corte
- Comitato Assistenza Bambini of the Lega Italiana per la Lotta contro i Tumori (CAB LILT), Treviso.
| | - Roberto Michielon
- Comitato Assistenza Bambini of the Lega Italiana per la Lotta contro i Tumori (CAB LILT), Treviso.
| | - Alessandro Gava
- Radiotherapy Department, Ca' Foncello Hospital and LILT, Treviso.
| | - Paola Midrio
- Pediatric Surgery Department, Ca' Foncello Hospital, Treviso.
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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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Affiliation(s)
- S Heikal
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - G Stuart
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Härter V, Barkmann C, Wiessner C, Rupprecht M, Reinshagen K, Trah J. Effects of Educational Video on Pre-operative Anxiety in Children - A Randomized Controlled Trial. Front Pediatr 2021; 9:640236. [PMID: 34055683 PMCID: PMC8149614 DOI: 10.3389/fped.2021.640236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Audio-visual interventions have been used to provide relevant patient information to reduce pre-operative anxiety in children. The aim of the study was to investigate whether self-reported state anxiety in children could be reduced by presenting a child-friendly educational video on the day of surgery. Methods: A prospective, single-blinded, two-armed, randomized controlled study was designed with three measurement time points including 90 children (6-17 years) and their parents. In the intervention group (IG), the children and their parents were shown a child-friendly video explaining the perioperative procedures that would be applied during the hospital stay, in addition to receiving standard information. In the control group (CG), children and parents received standard information provided by the nursing staff. The primary outcome was any change in the children's pre-operative state anxiety levels, as measured by the State-Trait Operation Anxiety Inventory (STOA). A secondary outcome was patient satisfaction regarding the received information. Results: Anxiety was significantly reduced in both groups after receiving either the intervention plus standard information or the standard information only. No significant difference in anxiety reduction was observed between the IG and the CG. However, the children and parents in the IG reported fewer worries than those in the CG. Conclusion: A child-friendly, educational video can be an additional tool for providing patient information and reducing pre-operative anxiety in children and their parents. Further studies should focus on the timing of the intervention and on age- and developmentally appropriate information formats and contents to address children's pre-operative anxiety. Clinical Trial Registration: Patient Anxiety Reduction in Children by Using Simple Explanation Videos, ID: NCT0441377; www.clinicaltrials.gov, Data Sharing Statement: Deidentified individual participant data will not be made available.
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Affiliation(s)
- Valentina Härter
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Wiessner
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Rupprecht
- Department of Pediatric Orthopedics, Altona Children's Hospital, Hamburg, Germany.,Department of Orthopedics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Trah
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chow CHT, Schmidt LA, Buckley DN. The role of anxiety and related states in pediatric postsurgical pain. Can J Pain 2020; 4:26-36. [PMID: 33987517 PMCID: PMC7942768 DOI: 10.1080/24740527.2020.1847600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/25/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022]
Abstract
Background: Nearly 20% of children and adolescents have pain with disability 1 year after surgery, and they experience poor sleep, school absence, and decreased activities. Negative clinical, psychological, and developmental effects include greater pain medication use, longer recovery, and fear of future medical care. Research has found psychological and family influences (i.e., child and parental anxiety) on pediatric chronic postsurgical pain (CPSP), but a better understanding of the role of perioperative anxiety and its related states in predicting pediatric postsurgical pain is needed. The poor understanding of the causes of child CPSP can lead to misdiagnosis and inadequate treatment, with significant short- and long-term effects. Objectives: The aim of this review was to summarize the literature on children's perioperative anxiety and parental anxiety in relation to acute postsurgical pain, CPSP, and pain trajectories. We also examined other related psychological factors (i.e., anxiety sensitivity, catastrophizing, pain anxiety, and fear of pain) in relation to pediatric acute and chronic postsurgical pain. Lastly, we discuss the interventions that may be effective in reducing children's and parents' preoperative anxiety. Conclusions: Our findings may improve the understanding of the causes of CPSP and highlight the gaps in research and need for further study.
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Affiliation(s)
- Cheryl H. T. Chow
- Department of Psychology, Neuroscience & Behavior, McMaster University, Hamilton, Ontario, Canada
| | - Louis A. Schmidt
- Department of Psychology, Neuroscience & Behavior, McMaster University, Hamilton, Ontario, Canada
| | - D. Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
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30
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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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Pilot Examination of the Efficacy of the Internet-Delivered, Preoperative, Preparation Program (I-PPP). J Clin Psychol Med Settings 2020; 28:627-636. [PMID: 33247796 DOI: 10.1007/s10880-020-09754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to compare the Internet-delivered, preoperative program (I-PPP) in alleviating anxiety in children undergoing outpatient surgery delivered alone (I-PPP) and in conjunction with parental presence (I-PPP + parent) to treatment as usual (TAU). 104 children undergoing day surgery procedures at a local hospital and their parents/guardians participated. Primary outcome measures: (a) observer-rated child anxiety and (b) induction compliance. Results demonstrated an interaction between the I-PPP and TAU groups over time, F(1, 64) = 5.11, p = .027, partial η p 2 = .07. At anesthetic induction, the I-PPP group demonstrated lower observer-rated anxiety than TAU, F(1, 64) = 4.72, p = .034, η p 2 = .07. I-PPP group demonstrated the best anesthesia induction compliance, F(1, 64) = 4.84, p = .031, η p 2 = .07. Our findings demonstrate that the I-PPP is an efficacious preoperative preparation intervention for children. The 'real-world' uptake and integration of the I-PPP into pediatric preoperative settings require exploration going forward. Trial retrospectively registered March 2019 (Open Science Registration https://doi.org/10.17605/osf.io/2x8rg ).
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Lee JH, Choi S, Lee M, Jang YE, Kim EH, Kim JT, Kim HS. Effect of magnesium supplementation on emergence delirium and postoperative pain in children undergoing strabismus surgery: a prospective randomised controlled study. BMC Anesthesiol 2020; 20:289. [PMID: 33208099 PMCID: PMC7672912 DOI: 10.1186/s12871-020-01192-7] [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: 08/20/2020] [Accepted: 10/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background The benefits of intraoperative magnesium supplementation have been reported. In this prospective, randomized study, the effects of magnesium supplementation during general anaesthesia on emergence delirium and postoperative pain in children were evaluated. Methods A total of 66 children aged 2 to 5 years who underwent strabismus surgery were assigned to the magnesium or to the control group. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale. After anaesthesia induction, the magnesium group received an initial loading dose of 30 mg/kg magnesium sulphate over 10 min and, then, continuous infusion of 10 mg/kg per h until 10 min before the end of the surgery. The control group received an equal volume of normal saline via the same regimen. The Paediatric Anaesthesia Emergence Delirium (PAED) score, pain score, and respiratory events were assessed at the postanaesthetic care unit. Results Data obtained from 65 children were analyzed. The PAED and pain scores of the two groups did not differ significantly. There were 26 of 33 (78.8%) and 27 of 32 (84.4%) children with emergence delirium in the control and the magnesium groups, respectively (odds ratio 0.69, 95% CI 0.19–2.44; p = 0.561). The preoperative anxiety score was not significantly correlated with the PAED score. The incidence of respiratory events during the emergence period did not differ significantly between the two groups. Conclusions Magnesium supplementation during anaesthesia had no significant effects on the incidence of emergence delirium or postoperative pain in children undergoing strabismus surgery. Trial registration ClinicalTrials.gov (NCT03132701). Prospectively registered May 8, 2017.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Seungeun Choi
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Minkyoo Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Young-Eun Jang
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Eun-Hee Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Jin-Tae Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Hee-Soo Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
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Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial. Eur J Anaesthesiol 2020; 36:728-737. [PMID: 31356373 PMCID: PMC6738544 DOI: 10.1097/eja.0000000000001059] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pre-operative anxiety in children is very common and is associated with adverse outcomes. OBJECTIVE The aim of this study was to investigate if virtual reality exposure (VRE) as a preparation tool for elective day care surgery in children is associated with lower levels of anxiety, pain and emergence delirium compared with a control group receiving care as usual (CAU). DESIGN A randomised controlled single-blind trial. SETTING A single university children's hospital in the Netherlands from March 2017 to October 2018. PATIENTS Two-hundred children, 4 to 12 years old, undergoing elective day care surgery under general anaesthesia. INTERVENTION On the day of surgery, children receiving VRE were exposed to a realistic child-friendly immersive virtual version of the operating theatre, so that they could get accustomed to the environment and general anaesthesia procedures. MAIN OUTCOME MEASURES The primary outcome was anxiety during induction of anaesthesia (modified Yale Preoperative Anxiety Scale, mYPAS). Secondary outcomes were self-reported anxiety, self-reported and observed pain, emergence delirium, need for rescue analgesia (morphine) and parental anxiety. RESULTS A total of 191 children were included in the analysis. During induction of anaesthesia, mYPAS levels (median [IQR] were similar in VRE, 40.0 [28.3 to 58.3] and CAU, 38.3 [28.3 to 53.3]; P = 0.862). No differences between groups were found in self-reported anxiety, pain, emergence delirium or parental anxiety. However, after adenoidectomy/tonsillectomy, children in the VRE condition needed rescue analgesia significantly less often (55.0%) than in the CAU condition (95.7%) (P = 0.002). CONCLUSION In children undergoing elective day care surgery, VRE did not have a beneficial effect on anxiety, pain, emergence delirium or parental anxiety. However, after more painful surgery, children in the VRE group needed rescue analgesia significantly less often, a clinically important finding because of the side effects associated with analgesic drugs. Options for future research are to include children with higher levels of anxiety and pain and to examine the timing and duration of VRE. TRIAL REGISTRATION Netherlands Trial Registry: NTR6116.
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Eijlers R, Staals LM, Legerstee JS, Berghmans JM, Strabbing EM, van der Schroeff MP, Wijnen RMH, Kind LS, Hillegers MHJ, Dierckx B, Utens EMWJ. Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival. J Clin Psychol Med Settings 2020; 28:313-322. [PMID: 32306238 PMCID: PMC8192387 DOI: 10.1007/s10880-020-09716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children.
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Affiliation(s)
- Robin Eijlers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Johan M Berghmans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
- Department of Anaesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Elske M Strabbing
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Dutch Craniofacial Centre, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Laura S Kind
- Centre for Special Care Dentistry, CBT Rijnmond, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Centre for Child Psychiatry De Bascule, Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
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Aleo Luján E, Lopez-Picado A, Rivas A, Joyanes Abancens B, Rodríguez Rojo ML, Fernández García P, Soto Beauregard C, Rodríguez Alarcón J, González Perrino C, San Pedro de Urquiza B, Arias E, Rodriguez D, Esteban Polonio C, Torrejón MJ. Pre-operative anxiolysis in children through a combined pharmacological therapy with hydroxyzine and a non-pharmacological distraction technique with a clown (SONRISA): study protocol for randomised double-blind clinical trial. Trials 2020; 21:1. [PMID: 31898511 PMCID: PMC6941242 DOI: 10.1186/s13063-019-3906-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background Surgery can generate significant stress and anxiety in up to 70% of the paediatric population. There are several pharmacological and non-pharmacological strategies to reduce pre-operative anxiety in children, however, they have several side effects and the available information about them is contradictory. The role of clowns and hydroxyzine in the management of anxiety is controversial, with some studies supporting and others contraindicating both strategies. Methods We propose a randomised double-blind, controlled clinical trial that will evaluate the effectiveness of both interventions (hydroxyzine and clowns), alone or in combination, to reduce pre-operative anxiety (using the modified Yale scale of preoperative anxiety) in children aged 2–16 years undergoing outpatient surgery (n = 188). Subjects will be randomised into two groups – (1) standard procedure (parental accompaniment) combined with placebo or (2) standard procedure combined with preoperative hydroxyzine. After randomisation, they will be divided by chance into two further groups, depending on the presence of clowns on the patient’s surgery day. Control of pre-operative anxiety will be determined in the four groups by a modified Yale scale of preoperative anxiety and cortisol levels. Compliance of children during induction of anaesthesia, time until anaesthesia recovery, presence of postoperative delirium and use of analgesia until discharge will be also assessed. For additional information, the children, parents and healthcare professionals involved in the study will complete a satisfaction survey. Conclusions This study aims to gather evidence on which of these four therapeutic options achieves the highest reduction of pre-operative anxiety with the best safety profile to allow paediatricians and anaesthesiologists to use the most effective and safe option for their patients. Trial registration ClinicalTrials.gov identifier: NCT03324828. Registered 21 September 2017.
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Affiliation(s)
- Esther Aleo Luján
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain. .,Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Amanda Lopez-Picado
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana Rivas
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Departamento de Enfermería, Facultad Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Joyanes Abancens
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.,Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Marina Laura Rodríguez Rojo
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Patricia Fernández García
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Carmen Soto Beauregard
- Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Servicio de Cirugía Pediátrica, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jaime Rodríguez Alarcón
- Servicio de Cirugía Pediátrica, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Departamento de Pediatría, Facultad de Medicina Universidad Francisco de Vitoria, Madrid, Spain
| | - Carlos González Perrino
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Borja San Pedro de Urquiza
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Eva Arias
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Diamelis Rodriguez
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Carmen Esteban Polonio
- Supervisora de Enfermería del Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Maria José Torrejón
- Servicio de Análisis Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Stein Duker LI, Schmidt AR, Pham PK, Ringold SM, Nager AL. Use of Audiobooks as an Environmental Distractor to Decrease State Anxiety in Children Waiting in the Pediatric Emergency Department: A Pilot and Feasibility Study. Front Pediatr 2020; 8:556805. [PMID: 33585358 PMCID: PMC7874121 DOI: 10.3389/fped.2020.556805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Anxiety and anticipatory stressors are commonly experienced by children visiting the Pediatric Emergency Department (PED), but little research exists that addresses the efficacy of interventions to decrease this stress. This one-sample pretest-postest pilot study gathered preliminary data on the feasibility and effectiveness of utilizing audiobooks to reduce fear and state anxiety in children in the PED. Methods: Participants were 131 children in kindergarten through 8th grade (M = 9.4 years, 54% female), triaged urgent or emergent, presenting to the PED. Participants self-reported fear (Children's Fear Scale) and state anxiety (modified State-Trait Anxiety Inventory for Children; mSTAIC) before and after listening to an age-appropriate audiobook (two options). Data regarding patient experience were also collected. Paired samples t-test was used to examine pre-post intervention changes in fear and state anxiety. Results: Significant, albeit small, improvements in fear and the mSTAIC states of nervous, calm, happy, and relaxed were found after use of the audiobook (Cohen's d z = 0.22-0.35). Small, yet significant correlations were found between child age/grade level and improvements in fear and in the mSTAIC states of scared and relaxed, suggesting that the audiobook was more beneficial for older participants. Over 60% of participants liked the audiobook content "a lot" as well as enjoyed listening to the audiobook "a lot." Without prompting, 15% of participants requested to listen to an additional audiobook. Conclusions: Listening to an audiobook is feasible and could be effective in decreasing fear and state anxiety for children during a waiting period in the PED. The technology is low-cost, simple, and portable. The results of this study should be interpreted with prudence due to the lack of a control group and results that, although significant, were modest based on effect size conventions; future studies should explore the impact of audiobooks on patient stress with an expanded sample size and control group.
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Affiliation(s)
- Leah I Stein Duker
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Anita R Schmidt
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Phung K Pham
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sofronia M Ringold
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Alan L Nager
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
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Biddiss E, Knibbe TJ, Fehlings D, McKeever P, McPherson A. Positive Distraction in Pediatric Healthcare Waiting Spaces: Sharing Play Not Germs through Inclusive, Hands-Free Interactive Media. Dev Neurorehabil 2019; 22:445-452. [PMID: 30235044 DOI: 10.1080/17518423.2018.1518351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To investigate the value of shared opportunities for positive distraction in pediatric healthcare environments. Methods: Self-selected activities of 271 young people (5-19 years) with diverse neurodevelopmental conditions were observed in an ambulatory pediatric rehabilitation clinic. Shared opportunities included hands-free media (nature video or interactive media) and an aquarium. Anxiety was self-reported on the State Trait Anxiety Scale upon arrival and after 10 minutes in the waiting space. Results: Young people engaged more with shared opportunities for distraction (n = 170/271) than personal items brought from home (n = 119/271), p = 0.02. Personal electronic devices were used by 67 young people, but did not positively impact anxiety. Interactive media and the aquarium significantly reduced anxiety (p < 0.04) while the nature video appeared to increase anxiety (p = 0.036). Age influenced activity preference and anxiety. Shared, hands-free interactive media engaged individuals of diverse age and mobility. Conclusion: Shared opportunities for positive distraction in healthcare facilities are valuable, particularly hands-free interactive media.
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Affiliation(s)
- Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada.,Institute of Biomaterials & Biomedical Engineering, University of Toronto , Toronto , Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada
| | - Tara Joy Knibbe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada.,Department of Paediatrics, University of Toronto , Toronto , Canada
| | - Patricia McKeever
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada.,Lawrence S. Bloomberg School of Nursing, University of Toronto , Toronto , Canada
| | - Amy McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto , Canada.,Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
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Du Z, Zhang X, Qu S, Song Z, Wei S, Xiang Z, Guo Q. The comparison of dexmedetomidine and midazolam premedication on postoperative anxiety in children for hernia repair surgery: A randomized controlled trial. Paediatr Anaesth 2019; 29:843-849. [PMID: 31125470 PMCID: PMC6852055 DOI: 10.1111/pan.13667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 05/07/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perioperative anxiety is common in pediatric patients undergoing surgery. AIMS The aim of this study was to determine whether an infusion of dexmedetomidine prior to hernia repair in children provides better postoperative anxiety outcomes that a preoperative infusion of midazolam. METHODS Ninety 6-11-year-old children, who were scheduled to undergo elective hernia repair, were enrolled for this double-blind, randomized controlled trial. Group D (n = 45) received an intravenous infusion of dexmedetomidine (0.5 μg/kg) and Group M (n = 45) received an intravenous infusion of midazolam (0.08 mg/kg) in 20 mL of normal saline for 10 minutes before the induction of anesthesia. Pre- and postoperative scores on the modified Yale Preoperative Anxiety Scale were the main outcomes. Secondary outcomes included systolic blood pressure, diastolic blood pressure, heart rate, and postoperative pain measured on a visual analogue scale and patient satisfaction using a numerical rating scale. RESULTS Postoperative anxiety in Group D was significantly lower than preoperative anxiety (2 hours postoperatively mean difference [95% CI]: 2.83 [0.87-4.79], P = 0.036, 4 hours postoperatively mean difference [95% CI]: 3.29 [1.39-5.20], P = 0.005). Preoperative and postoperative anxiety in Group M was similar. Anxiety scores in Group D were also significantly lower than anxiety in Group M 2 hours (mean difference [95% CI]: 1.89 [0.52-3.26], P = 0.01) and 4 hours (mean difference [95% CI]: 3.32 [1.98-4.66], P < 0.001) postoperatively. Systolic blood pressure, diastolic blood pressure and heart rate were lower in Group D than in Group M after administration of sedative drugs until children left PACU (SBP mean difference [95% CI]: 13.87 [10.30-17.43], P < 0.001, DBP mean difference [95% CI]: 5.96[3.80-8.11], P < 0.001, HR mean difference [95% CI]: 10.36 [7.58-13.13], P < 0.001). Pain was also significantly lower in Group D than in Group M at 2 hours (median difference [95% CI]: 1 [0.26-1.34], P = 0.004), 4 hours (median difference [95% CI]: 1 [0.31-1.02], P = 0.003), and 1 day (median difference [95% CI]: 0 [0.22-0.76], P = 0.003) postoperatively. Patient satisfaction scores were significantly higher in Group D than in Group M 1 day (median difference [95% CI]: 0 [-0.83 to -0.24], P = 0.006) and somewhat higher 1 week (median difference [95% CI]: 0 [-0.67 to -0.04], P = 0.06) postoperatively. CONCLUSION Compared with midazolam, a single preoperative intravenous dose of dexmedetomidine appears to provide better postoperative anxiolytic effects for children undergoing same-day surgery.
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Affiliation(s)
- Zhen Du
- Department of AnesthesiologyXiangya Hospital of Central South UniversityChangshaChina
| | - Xi‐Ying Zhang
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Shuang‐Quan Qu
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Zong‐Bing Song
- Department of AnesthesiologyXiangya Hospital of Central South UniversityChangshaChina
| | - Si‐Wei Wei
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Zhen Xiang
- Department of AnesthesiologyHunan Children' HospitalChangshaChina
| | - Qu‐Lian Guo
- Department of AnesthesiologyXiangya Hospital of Central South UniversityChangshaChina
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Könsgen N, Polus S, Rombey T, Pieper D. Clowning in children undergoing potentially anxiety-provoking procedures: a systematic review and meta-analysis. Syst Rev 2019; 8:178. [PMID: 31324215 PMCID: PMC6642518 DOI: 10.1186/s13643-019-1095-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The operation areas of clowns in the medical context are multifaceted. Clowning in children undergoing surgery has been shown to be able to lessen children's anxiety. Hence, our aim was to assess the effectiveness of clowning on anxiety in children undergoing potentially anxiety-provoking procedures. METHODS We searched MEDLINE, CENTRAL, and EMBASE for randomized controlled trials (RCTs) in December 2018. The primary outcome was children's anxiety. We used the Cochrane risk of bias tool to assess risk of bias of the included studies. RESULTS We found eleven RCTs including 733 children. Their risk of bias was relatively high. Children undergoing clowning were significantly less anxious in preoperative time compared to parental presence or no intervention (mean difference (MD) - 7.16; 95% CI - 10.58, - 3.75) and in operation, induction, or patient room (MD - 20.45; 95% CI - 35.54, - 5.37), but not during mask application or physician examination (MD 2.33; 95% CI - 4.82, 9.48). Compared with midazolam, children's anxiety was significantly lower in preoperative time (MD - 7.60; 95% CI - 11.73, - 3.47), but not in the induction room (MD - 9.63; 95% CI - 21.04, 1.77). CONCLUSIONS Clowning seems to lower children's anxiety, but because of the increased risk of bias of included studies and the very low quality of evidence, these results should be considered with caution. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016039045.
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Affiliation(s)
- Nadja Könsgen
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Stephanie Polus
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Tanja Rombey
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.
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Park SH, Park S, Lee S, Choi JI, Bae HB, You Y, Jeong S. Effect of transportation method on preoperative anxiety in children: a randomized controlled trial. Korean J Anesthesiol 2019; 73:51-57. [PMID: 31304694 PMCID: PMC7000284 DOI: 10.4097/kja.19191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was performed to evaluate the effect of a wagon as a transport vehicle instead of the standard stretcher car to reduce children's anxiety of separation from parents. The secondary goal was to evaluate whether this anxiolytic effect was related to age. METHODS We divided 80 children (age 2-7 years) into two groups. The stretcher group was transferred to the operating room on a conventional stretcher car, whereas the wagon group was transferred using a wagon. The level of anxiety was evaluated three times using the Modified Yale Preoperative Anxiety Scale (mYPAS): in the waiting area (T0), in the hallway to the operating room (T1), and before induction of anesthesia (T2). RESULTS The mYPAS score was significantly lower in the wagon group (36.7 [31.7, 51.7]) than in the stretcher group (51.7 [36.7, 83.3]) at T1 (P = 0.007). However, there was no difference in the mYPAS score between the two groups at T2 (46.7 [32.5, 54.2] vs. 51.7 [36.7, 75.0], respectively, P = 0.057). The baseline anxiety tended to be lower with increasing age (r = -0.248, P = 0.031). During transportation to the operating room, the increase in the mYPAS score (T1-T0) was greater as the age of children decreased in the stretcher group (r = -0.340, P = 0.034). However, no correlation was observed in the wagon group (r = -0.053, P = 0.756). CONCLUSION The wagon method decreased preoperative anxiety, suggesting that it may be a good alternative for reducing preoperative anxiety in children.
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Affiliation(s)
- Sun-Hong Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Sanghee Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seongheon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jeong Il Choi
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Youngwook You
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seongtae Jeong
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Easing anxiety in preparation for pediatric magnetic resonance imaging: a pilot study using animal-assisted therapy. Pediatr Radiol 2019; 49:1000-1009. [PMID: 31030334 DOI: 10.1007/s00247-019-04407-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 03/15/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Children undergoing magnetic resonance imaging (MRI) can experience negative emotions both before and during their scan, causing them to move and often necessitating the use of procedural sedation. Several strategies to improve patient compliance have been attempted. OBJECTIVE This study was designed to evaluate the effectiveness of a non-pharmacological intervention to reduce anxiety in pediatric patients preparing for MRI using animal-assisted therapy. MATERIALS AND METHODS An animal intervention pilot study was performed in patients who agreed in advance to interact with a dog. Patients and caregivers filled out questionnaires, including questions designed to capture changes in patient emotion before and after the intervention. MRI diagnostic quality was compared to age- and gender-matched control groups with and without general anesthesia. RESULTS The intervention in 21 patients comparing pre- and post-scan surveys demonstrated a statistically significant improvement in patient anxiety levels (P<0.01). Diagnostic MRI scans were achieved in 19/21 (90%), with no significant difference in exam quality or times compared against control groups. The majority of caregivers and staff members agreed strongly that patients benefited from the therapy dog's presence. CONCLUSION The use of animal-assisted therapy in a pilot group in our MRI division resulted in a beneficial effect on patients' emotional status, easing anxiety in preparation for scheduled scans, without impacting MRI quality or duration. Further randomized studies will be needed to demonstrate its significance in reducing sedation rates in children undergoing MRI.
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Hatipoğlu Z, Kırdök O, Özcengiz D. Validity and reliability of the Turkish version of the modified Yale Preoperative Anxiety Scale. Turk J Med Sci 2019; 49:730-737. [PMID: 31091856 PMCID: PMC7018250 DOI: 10.3906/sag-1612-113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background/aim The modified Yale Preoperative Anxiety Scale (m-YPAS) is widely used to measure children’s anxiety levels. The aim of this study was to translate the m-YPAS into Turkish and test its validity and reliability in Turkish children. Materials and methods The English version of the m-YPAS was translated into Turkish using the forward-back-forward translation technique. This study enrolled 120 children. The m-YPAS was administered to 120 children who were recorded on video. The State-Trait Anxiety Inventory for Children (STAIC) was used for only 30 of 120 children. The videotapes were evaluated by two experienced observers [an anesthesiologist, ObA(an), and a psychologist, ObB(ps)]. The interrater reliability, concurrent validity, sensitivity, specificity, and positive and negative predictive values were analyzed. Results The mean age of the children was 7.8 ± 2.2 years. The weighted kappa values of the m-YPAS between observers were in substantial agreement (κw = 0.74–0.80) and almost perfect agreement (κw = 0.84–0.85). The Cronbach alpha values were high [α = 0.85 for ObA(an) and α = 0.86 for ObB(ps)]. The correlation between m-YPAS and STAIC showed good agreement (P < 0.05). The sensitivity and specificity were high, and the predictive value was 92.86%. Conclusion The Turkish version of the m-YPAS can be applied as a reliable and valid observational questionnaire for Turkish children.
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Affiliation(s)
- Zehra Hatipoğlu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Oğuzhan Kırdök
- Department of Psychological Counseling and Guidance, Faculty of Education, Çukurova University, Adana, Turkey
| | - Dilek Özcengiz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Çukurova University, Adana, Turkey
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Vagnoli L, Bettini A, Amore E, De Masi S, Messeri A. Relaxation-guided imagery reduces perioperative anxiety and pain in children: a randomized study. Eur J Pediatr 2019; 178:913-921. [PMID: 30944985 DOI: 10.1007/s00431-019-03376-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022]
Abstract
Several studies have shown the efficacy of psychological interventions in reducing preoperative anxiety in children undergoing surgery. This study aims to investigate the effectiveness of a specific non-pharmacological technique, the relaxation-guided imagery, in reducing both preoperative anxiety and postoperative pain in a sample of 60 children (6-12 years old) undergoing minor surgery who were randomly assigned to the experimental group (N = 30) or the control group (N = 30). The first group received the relaxation-guided imagery, before the induction of general anesthesia; the second group received standard care. The levels of preoperative anxiety and postoperative pain were assessed using, respectively, the modified Yale Preoperative Anxiety Scale and the Face, Legs, Activity, Cry, and Consolability Scale. The results showed a statistically significant difference between groups, with less anxiety and less pain for children included in the experimental group (p < .001; p < .001).Conclusion: Results suggest that relaxation-guided imagery reduces preoperative anxiety and postoperative pain in children. Future studies should focus on developing protocols and studying the eventual reduction of administered drugs for anesthesia and pain. What is Known: • Literature suggests the usefulness of relaxation-guided imagery in reducing anxiety and pain in the perioperative period. • Stronger evidences are needed to support the application of relaxation-guided imagery as routine care in pediatric surgery. What is New: • To our knowledge, this is the first randomized study to investigate the efficacy of relaxation-guided imagery in reducing preoperative anxiety and postoperative pain within a single pediatric sample. • The present study provides stronger evidence in an area that is lacking in research.
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Affiliation(s)
- Laura Vagnoli
- Pediatric Psychology, Meyer Children's Hospital, Via G. Pieraccini 24, 50139, Florence, Italy.
| | - Alessandra Bettini
- Pediatric Psychology, Meyer Children's Hospital, Via G. Pieraccini 24, 50139, Florence, Italy
| | - Elena Amore
- Pediatric Psychology, Meyer Children's Hospital, Via G. Pieraccini 24, 50139, Florence, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Meyer Children's Hospital, Via G. Pieraccini 24, 50139, Florence, Italy
| | - Andrea Messeri
- Pain Service & Palliative Care, Meyer Children's Hospital, Via G. Pieraccini 24, 50139, Florence, Italy
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Verschueren S, van Aalst J, Bangels AM, Toelen J, Allegaert K, Buffel C, Vander Stichele G. Development of CliniPup, a Serious Game Aimed at Reducing Perioperative Anxiety and Pain in Children: Mixed Methods Study. JMIR Serious Games 2019; 7:e12429. [PMID: 31199333 PMCID: PMC6592492 DOI: 10.2196/12429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/20/2019] [Accepted: 04/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background An increasing number of children undergo ambulatory surgery each year, and a significant proportion experience substantial preoperative anxiety and postoperative pain. The management of perioperative anxiety and pain remains challenging in children and is inadequate, which negatively impacts the physical, psychosocial, and economic outcomes. Existing nonpharmacological interventions are costly, time consuming, vary in availability, and lack benefits. Therefore, there is a need for an evidence-based, accessible, nonpharmacological intervention as an adjunct to existing pharmacological alternatives to reduce perioperative anxiety and pain in children undergoing ambulatory surgery. Technology-enabled interventions have been proposed as a method to address the unmet need in this setting. In particular, serious games hold a unique potential to change health beliefs and behaviors in children. Objective The objective of this research was to describe the rationale, scientific evidence, design aspects, and features of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods The SERES Framework for serious game development was used to create the serious game, CliniPup. In particular, we used a mixed methods approach that consisted of a structured literature review supplemented with ethnographic research, such as expert interviews and a time-motion exercise. The resulting scientific evidence base was leveraged to ensure that the resulting serious game was relevant, realistic, and theory driven. A participatory design approach was applied, wherein clinical experts qualitatively reviewed several versions of the serious game, and an iterative creative process was used to integrate the applicable feedback. Results CliniPup, a serious game, was developed to incorporate a scientific evidence base from a structured literature review, realistic content collected during ethnographic research such as expert interviews, explicit pedagogical objectives from scientific literature, and game mechanics and user interface design that address key aspects of the evidence. Conclusions This report details the systematic development of CliniPup, a serious game aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Clinical experts validated CliniPup’s underlying scientific evidence base and design foundations, suggesting that it was well designed for preliminary evaluation in the target population. An evaluation plan is proposed and briefly described.
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Affiliation(s)
| | - June van Aalst
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Buffel C, van Aalst J, Bangels AM, Toelen J, Allegaert K, Verschueren S, Vander Stichele G. A Web-Based Serious Game for Health to Reduce Perioperative Anxiety and Pain in Children (CliniPup): Pilot Randomized Controlled Trial. JMIR Serious Games 2019; 7:e12431. [PMID: 31199324 PMCID: PMC6592396 DOI: 10.2196/12431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was developed to address this unmet need. CliniPup was generated using the SERES framework for serious game development. Objective The goal of the research was to clinically evaluate CliniPup as an adjunct therapy to existing pharmacological interventions aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. Methods CliniPup was evaluated in a prospective randomized controlled pilot trial in 20 children aged 6 to 10 years who underwent elective surgery and their parents. Study participants were randomly assigned to the test (n=12) or control group (n=8). Children in the test group played CliniPup 2 days prior to surgery, and children in the control group received standard of care. On the day of surgery, pediatric anxiety was measured with the modified Yale Preoperative Anxiety Scale and parental anxiety was assessed with the State-Trait Anxiety Inventory. Pediatric postoperative pain was assessed by the Wong-Baker Faces Pain Rating Scale. Child and parent user experience and satisfaction were also evaluated in the test group using structured questionnaires. Results Despite the small sample, preoperative anxiety scores were significantly lower (P=.01) in children who played CliniPup prior to surgery compared to controls. Parental preoperative anxiety scores were also lower in the test group (P=.10) but did not reach significance. No significant differences were observed in postoperative pain scores between groups (P=.54). The evaluation of user experience and satisfaction revealed that both children and parents were satisfied with CliniPup and would recommend the game to peers. Conclusions Results of the pilot trial introduce CliniPup as a potentially effective and attractive adjunct therapy to reduce preoperative anxiety in children undergoing ambulatory surgery with a trend toward positive impact on parental preoperative anxiety. These results support the use of the SERES framework to generate an evidence-based SGH that results in positive health outcomes for patients. Based on these preliminary findings, we propose a research agenda to further develop and investigate this tool. Trial Registration ClinicalTrials.gov NCT03874442; https://clinicaltrials.gov/ct2/show/NCT03874442 (Archived by WebCite at http://www.webcitation.org/78KZab8qc)
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Affiliation(s)
| | - June van Aalst
- Division of Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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Stenberg U, Haaland-Øverby M, Koricho AT, Trollvik A, Kristoffersen LGR, Dybvig S, Vågan A. How can we support children, adolescents and young adults in managing chronic health challenges? A scoping review on the effects of patient education interventions. Health Expect 2019; 22:849-862. [PMID: 31131527 PMCID: PMC6803408 DOI: 10.1111/hex.12906] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives This scoping review aims to give a comprehensive and systematic overview of published evaluations and the potential impact of patient education interventions for children, adolescents and young adults who are living with chronic illness and/or impairment loss. Methods Relevant literature published between 2008 and 2018 has been comprehensively reviewed, with attention paid to variations in study, intervention and patient characteristics. Arksey and O'Malley's framework for scoping studies guided the review process, and thematic analysis was undertaken to synthesize extracted data. Results Of the 7214 titles identified, 69 studies were included in this scoping review. Participant‐reported benefits of the interventions included less distress from symptoms, improved medical adherence and/or less use of medication, and improved knowledge. The majority of studies measuring physical activity and/or physiologic outcomes found beneficial effects. Interventions were also beneficial in terms of decreased use of urgent health care, hospitalization, visits to general practitioner and absence from school. By sharing experiences, participants had learned from each other and attained new insight on how they could manage illness‐related challenges. Discussion Study results corroborate previous research suggesting that different types of patient education interventions have a positive impact on children, adolescents and young adults, but research on this field is still in a starting phase. The results summed up in the current review supports the utility of patient education interventions that employ behavioural strategies tailored to the developmental needs of children, adolescents and young adults with different cultural backgrounds.
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Affiliation(s)
- Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | | | - Anne Trollvik
- Institute of Nursing, Faculty of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | | | | | - André Vågan
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
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Shi M, Miao S, Gu T, Wang D, Zhang H, Liu J. Dexmedetomidine for the prevention of emergence delirium and postoperative behavioral changes in pediatric patients with sevoflurane anesthesia: a double-blind, randomized trial. Drug Des Devel Ther 2019; 13:897-905. [PMID: 30936683 PMCID: PMC6421876 DOI: 10.2147/dddt.s196075] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Emergence delirium (ED) is a common neurologic complication that can not only distress children and their families in the early postanesthetic period, but can also have adverse effects on children in the long-term. This study aimed to investigate the effects of single-dose dexmedetomidine on ED in children with sevoflurane anesthesia and to observe postoperative behavioral changes through long-term follow-up. Methods Patients aged 2-7 years, American Society of Anesthesiologists class (ASA) I or II, scheduled for tonsillectomy with and without adenoidectomy were randomized to receive dexmedetomidine 0.5 μg/kg (Group D) or volume-matched normal saline (Group C) over 10 minutes after induction of anesthesia. The primary outcome was the incidence of ED within 30 minutes after extubation. Other outcomes were the incidence of pain, extubation time, post-anesthesia care unit (PACU) length of stay after extubation, adverse events, and the incidence of negative postoperative behavioral changes (NPOBCs). Results Ninety children completed the study. Compared with the control group (Group C), dexmedetomidine decreased the incidence of ED (31.1% vs 53.3%; P=0.033) and pain (28.9% vs 57.8%; P=0.006), but it prolonged extubation time (P⩽0.001). PACU length of stay after extubation and the percentage of adverse events were similar between groups. The incidence of NPOBCs in Group D was significantly lower at 1 and 7 days after discharge (33.3% vs 60.0%; P=0.011% and 24.4% vs 46.7%; P=0.028, respectively) than it was in Group C, but no significant difference was found at the 30th day. Conclusion Dexmedetomidine 0.5 μg/kg reduced the incidence of ED after sevoflurane anesthesia and might be used to prevent NPOBCs. Clinical trials registration ChiCTR1800016828.
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Affiliation(s)
- Mengzhu Shi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shuai Miao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tianchu Gu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dongyue Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hui Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jindong Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China,
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Kühlmann AY, Lahdo N, Staals LM, van Dijk M. What are the validity and reliability of the modified Yale Preoperative Anxiety Scale-Short Form in children less than 2 years old? Paediatr Anaesth 2019; 29:137-143. [PMID: 30365208 PMCID: PMC7379673 DOI: 10.1111/pan.13536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Accurate measurement of preoperative anxiety is important for pediatric surgical patients' care as well as for monitoring anxiety-reducing interventions. The modified Yale Preoperative Anxiety Scale-short form is well validated for this purpose in children aged 2 years and above, but not in younger children. AIMS We aimed to validate the Dutch version of the modified Yale Preoperative Anxiety Scale-short form for measuring preoperative anxiety in children less than 2 years old. METHODS Two investigators independently assessed infants' anxiety at the holding area and during induction of anesthesia with the modified Yale Preoperative Anxiety Scale-short form and the COMFORT-Behavior scale-live and from video observations. Construct validity and responsiveness of both scales were tested with Pearson correlation coefficient. Internal consistency of the modified Yale Preoperative Anxiety Scale-short form was assessed using Cronbach's α, and inter-rater reliability and intra-rater reliability were tested using the intraclass correlation coefficient and Cohen's linearly weighted kappa. Hypotheses for sufficient inter-rater reliability (r > 0.60) and validity (r > 0.65) had been formulated a priori in line with the COSMIN guidelines. RESULTS Behavior of 129 infants (89.1% male) with a median age of 6.5 months (range 0.9-16.5 months) was observed. The correlations between the modified Yale Preoperative Anxiety Scale-short form and COMFORT-Behavioral scale were strong at the holding area and at induction of anesthesia, as were the correlation of change scores between the holding area and induction. Internal consistency of the modified Yale Preoperative Anxiety Scale-short form was excellent at both the holding area and at induction of anesthesia. Inter-rater reliability was good to excellent on scale level and moderate to good on item level. CONCLUSION These findings support the validity and reliability of the Dutch version of the modified Yale Preoperative Anxiety Scale-short form in children less than 2-years-old.
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Affiliation(s)
- Anne Y.R. Kühlmann
- Department of Pediatric SurgeryErasmus University Medical CenterSophia Children's HospitalRotterdamThe Netherlands
| | - Nisson Lahdo
- Department of Pediatric SurgeryErasmus University Medical CenterSophia Children's HospitalRotterdamThe Netherlands
| | - Lonneke M. Staals
- Department of AnesthesiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Monique van Dijk
- Department of Pediatric SurgeryErasmus University Medical CenterSophia Children's HospitalRotterdamThe Netherlands,Department of Internal MedicineErasmus University Medical CenterRotterdamThe Netherlands
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Byun SH, Kim SJ, Kim E. Comparison of the clinical performance of the flexible laryngeal mask airway in pediatric patients under general anesthesia with or without a muscle relaxant: study protocol for a randomized controlled trial. Trials 2019; 20:31. [PMID: 30626406 PMCID: PMC6325664 DOI: 10.1186/s13063-018-3141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The insertion of a laryngeal mask airway (LMA) is difficult in children due to the unique features of their airways. Muscle relaxants have been reported to facilitate LMA insertion in adults; however, there is a lack of evidence supporting this in children. This trial is designed to assess the feasibility of LMA insertion with and without the use of muscle relaxants in pediatric patients under general anesthesia. METHODS/DESIGN This is a prospective, double-blind, single-center, parallel-arm, non-inferiority, randomized controlled trial to be conducted with participants aged 2-7 years who are undergoing elective ophthalmic surgery under general anesthesia. Participants are randomly assigned to one of two groups based on whether muscle relaxants are used (MR group, n = 64) or not used (Saline group, n = 64) prior to LMA insertion. The primary outcome is the oropharyngeal leak pressure (OLP) at a fixed gas flow of 3 L/min. The secondary outcomes are intubation time for successful insertion, ease of insertion and mask bagging, intubation attempt for successful insertion, successful insertion rate on the first attempt, fiberoptic view of the LMA position, postoperative complications, and changes in hemodynamic and ventilatory parameters. DISCUSSION We will compare the OLPs to determine whether the muscle relaxant provides better conditions for the manipulation of the LMA. This is the first randomized controlled trial to investigate whether muscle relaxants are beneficial to the clinical performance of LMA insertion in pediatric patients under general anesthesia. This trial will be a resource for improving the process and safety of pediatric LMA insertion under general anesthesia. TRIAL REGISTRATION ClinicalTrials.gov, NCT03487003 . Registered on 18 April 2018.
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Affiliation(s)
- Sung Hye Byun
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Hospital, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Soo Jin Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Eugene Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Hospital, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea. .,Present Address: Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Nakamura N, Mihara T, Hijikata T, Goto T, Ka K. Unilateral electrical stimulation of the heart 7 acupuncture point to prevent emergence agitation in children: A prospective, double-blinded, randomized clinical trial. PLoS One 2018; 13:e0204533. [PMID: 30304047 PMCID: PMC6179240 DOI: 10.1371/journal.pone.0204533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/31/2018] [Indexed: 11/19/2022] Open
Abstract
Background Emergence agitation (EA) is a frequent phenomenon in children recovering from general anaesthesia and increases the risk of self-injury. Previously, our group reported that stimulating the heart 7 (HT7) acupuncture point bilaterally using two neuromuscular transmission monitoring devices (NTMs) decreased the incidence of EA. However, bilateral stimulation is a barrier to clinical use because two NTMs are needed for one patient. Objective The objective of this study was to examine the efficacy of unilateral electrical stimulation of HT7 using an NTM to prevent EA in children. Design Prospective, double-blinded, randomized clinical trial. Setting Kanagawa Children’s Medical Centre, Yokohama, Japan. Patients One hundred children (ages 18–96 months) with ASA-PS I or II, who were scheduled to undergo inguinal hernia repair or orchiopexy under sevoflurane anaesthesia. Intervention Patients were randomly assigned to one of the following two groups: (1) HT7 group: unilateral (right side) stimulation of the HT7 acupuncture point using a single-twitch electrical stimulus (1 Hz, 50 mA) throughout the surgery, and (2) control group: electrodes alone were attached to the HT7 point on the right side; an electrical stimulus was not applied. Main outcome measures The primary outcome was the incidence of EA evaluated using the pediatric anaesthesia emergence delirium (PAED) scale. The secondary outcomes were the incidence of EA evaluated using Aono’s scale, the severity of EA, PACU stay duration, and postoperative pain. Results There was no statistical difference between the incidence of EA in the HT7 and the control group (28.0% and 24.0%, respectively; P > 0.99). The risk ratio was 1.17 (95% confidence interval: 0.60–2.27). Conclusions We observed that there was no effect of unilateral single-twitch electrical stimulation to the HT7 on the incidence of EA, contrary to the findings with bilateral HT7 stimulation.
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Affiliation(s)
- Nobuhito Nakamura
- Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takahiro Mihara
- Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Toshiyuki Hijikata
- Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koui Ka
- Department of Anesthesiology, Kanagawa Children's Medical Center, Yokohama, Japan
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