Research Progress on Risk Factors of Preoperative Anxiety in Children: A Scoping Review

Parent-reported experiences of in-laboratory polysomnography in children with neurodevelopmental disorders: A cross-sectional multi-centre study

PURPOSE

In-laboratory polysomnography (PSG) is the gold standard test for diagnosing certain paediatric sleep conditions. Children with neurodevelopmental disorders (NDD) often have difficulty tolerating PSG, but parent and patient experiences of PSG for children with NDD have not been thoroughly explored. The study aim was to evaluate the parent-reported experience of in-laboratory PSG undertaken in children with NDD and to identify factors predictive of poorer experience.

METHODS

In this cross-sectional multicentre study, parents of 143 children with NDD who underwent in-laboratory PSG completed a customised survey to provide feedback on parent and child worry levels, subjective tolerance and overall experience of PSG, and hypothetical preference between in-laboratory PSG versus an in-home mat-based sleep test. ANOVA, Chi-squared and Kruskal-Wallis tests were used to determine participant factors associated with these outcomes.

RESULTS

On average, parents rated their child's worry level with respect to undergoing PSG as 'moderate,' but their own worry levels lower. Autism spectrum / neuromuscular disorder diagnoses were risk factors for both higher worry score and reporting that sleep during PSG was non-representative of usual sleep at home. Parental preference was for in-home (mat-based) testing, with 57% indicating a preference for this if it wereavailable vs. 7% preferring in-laboratory testing.

CONCLUSION

Parent/carer reports regarding in-laboratory PSG experiences for their children with NDD suggest the test is associated with child worry and concerns that the sleep is not-representative of usual sleep at home. Consumer preference favours in-home sleep study testing over current in-laboratory diagnostic testing.

CLINICAL TRIAL REGISTRATION

This study is part of a larger trial ACTRN12622001544763.

The effect of social robot interventions on anxiety in children in clinical settings: a systematic review and meta-analysis

AIMS

Children in clinical settings are prone to anxiety due to developmental limitations, which hinders treatment progress. This systematic review and meta-analysis aimed to evaluate the efficacy of social robot interventions compared to routine care or alternative non-pharmacological strategies in reducing anxiety among children aged 4-12 years undergoing medical procedures in clinical settings, based on evidence from randomized controlled trials.

METHODS

The review protocol was prospectively registered in PROSPERO. Five electronic databases PubMed, Web of Science, Embase, Cochrane Library and PsycINFO were searched for randomized controlled trials (RCTs) examining the effects of SRs on children's anxiety. The search ends on 1 December 2024. A total of 10 RCTs meeting the inclusion criteria were identified, involving 877 children aged 4-12 years.

RESULTS

The meta-analysis reveals a significant reduction in anxiety levels among children who interacted with social robots in clinical settings. Subgroup analyses showed that 1) Both inpatient and outpatient children exhibited reduced anxiety levels. 2) School-age children experienced a decrease in anxiety following interventions with social robots. 3) The social robots were effective in alleviating children's anxiety using distraction techniques and psycho-educational interventions.

CONCLUSIONS

This meta-analysis is the first to summarize the effects of social robots on anxiety in children and finds an overall positive trend. It's more effective than traditional psychotherapy and has no adverse effects due to drug use. In the context of care shortages, social robots represent a significant tool for reducing anxiety among children in clinical settings and demonstrate promising potential.

A nested case-control analysis of factors influencing preoperative hospitalization fear in pediatric patients and the alleviating effects of child-friendly visual interventions

BACKGROUND

Preoperative fear in pediatric patients can significantly impact their psychological well-being and complicate perioperative care. Traditional hospital environments may exacerbate anxiety in children undergoing elective surgeries, especially given developmental differences across ages 2 to 12.

METHODS

In a retrospective hospital-based nested case-control study embedded within a cohort, we examined 188 children aged 2 to 12 admitted for elective surgery between March 2023 and March 2024. Participants met specific inclusion criteria and We defined cases as those with a Child Medical Fear Scale (CMFS) score > 30 (High Fear Group) and controls as those with CMFS ≤ 30 (Low Fear Group). Further stratification was based on hospitalization in conventional wards a conventional environment versus specially designed wards featuring "child-friendly visual intervention strategies" (e.g., cartoon themes, interactive toys, multimedia TVs). Standard Routine pre-hospital care (Treatment as Usual) and detailed procedural explanations were provided. Fear Preoperative fear was assessed using the CMFS at admission and before surgery, while parental satisfaction was evaluated with the Patient Satisfaction Questionnaire Short Form (PSQ-18).

RESULTS

Among 188 children (mean age 7.57 ± 2.15 years; 64/124 male), 74 cases (high fear) and 71 controls (low fear) were analyzed. No significant demographic differences were observed between groups. Key correlates of higher fear included lower educational status (OR = 0.400, 95% CI = 0.200-0.801; P = 0.010) and higher ASA status (OR = 2.273, 95% CI = 1.035-4.989; P = 0.041). Environmental stressors such as visibility of sharp instruments (OR = 2.294, 95% CI = 1.048-5.021; P = 0.038) and observing injections (OR = 2.565, 95% CI = 1.183-5.557; P = 0.017) were significant anxiety factors. The child-friendly intervention group (n = 43) exhibited significantly lower fear scores across all dimensions compared to the conventional group (n = 35), with a higher proportion achieving CMFS ≤ 30 (76.74% vs. 51.43%; P = 0.019) and greater parental satisfaction (79.07% vs. 51.43%; P = 0.010).

CONCLUSION

Both individual (e.g., educational status, past hospital experiences) and environmental factors (e.g., visibility of needles) play critical roles in pediatric preoperative fear. Implementing child-friendly visual interventions significantly alleviates reduces anxiety and improves parental satisfaction. These findings Our results support the adoption of such strategies in pediatric surgical care and highlight the importance of age-appropriate interventions.

Cooperative Virtual Reality Gaming for Anxiety and Pain Reduction in Pediatric Patients and Their Caregivers During Painful Medical Procedures: Protocol for a Randomized Controlled Trial

BACKGROUND

The hospital experience is often marked by fear and pain, particularly for children undergoing medical procedures. Sedation is commonly used to alleviate patient anxiety, but it poses additional health risks. Caregivers, usually the parents, also experience emotional distress during the child's hospital stay, which can further exacerbate the child's anxiety and pain. While various interventions exist to ease patient distress, few consider the emotional well-being of caregivers.

OBJECTIVE

This study aims to explore the effectiveness of a cooperative virtual reality (VR) game as a novel nonpharmacological solution to reduce anxiety and pain for both pediatric patients and their caregivers during medical procedures. Specifically, we aim to investigate whether the VR game "Sweet Dive VR" (SDVR), designed for children aged between 6 and 12 years to play with 1 caregiver, can alleviate anxiety and pain during different types of needle punctures and Kirschner-wire removal.

METHODS

A prospective multicenter randomized clinical trial will be conducted. Eligible participants will be identified by scanning the hospital information system, and group allocation will follow stratified randomization. During the medical procedure, patients in the VR condition will play SDVR with a caregiver present, while patients in the control group will listen to a recording of gently crashing waves. Data collection will be carried out through self-reports of patients and caregivers using visual analog scales and questionnaires at 2 measurement time points: before and after the intervention. In addition, observation by the interviewers will occur during the intervention to capture emotional and pain reactions as well as interaction quality between patients and caregivers and smoothness of the procedure flow using a structured observation protocol. The measured variables will encompass patient affect and pain, caregiver affect, player experience, patient experience, and the flow of the procedure.

RESULTS

As of November 2024, we enrolled 39 patients and caregivers, 28 of whom completed the study. Data collection is still ongoing.

CONCLUSIONS

Cooperative VR gaming, as exemplified by SDVR, emerges as a promising intervention to address anxiety and pain in pediatric patients while involving caregivers to support the emotional well-being of both parties. Our approach strives to foster positive shared experiences and to maintain trust between children and caregivers during emotionally challenging medical situations.

TRIAL REGISTRATION

German Clinical Trial Register (DRKS) DRKS00033544; https://drks.de/search/en/trial/DRKS00033544.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63098.

School Performance and Learning Challenges in Children and Adolescents with Congenital Heart Disease

Children with congenital heart disease are at risk for neurocognitive and neurodevelopmental challenges, learning disabilities, and psychosocial difficulties. Our narrative review draws literature-based evidence for the effect of congenital heart disease on school performance. We conducted a literature review and extracted relevant articles from Google Scholar, Medline, and PubMed. Evidence showcases that school performance is impacted directly by congenital heart disease. This seems to be underlined by different factors inherent to congenital heart disease, like inattention, language difficulties, and decreased fine and gross motor skills. Moreover, the operative and postoperative periods present various physical challenges that can hinder development, ultimately affecting daily activities and quality of life. The consequent stressors in childhood can have long-lasting effects, leading to an increased prevalence of anxiety and depression affecting patients as they transition into adolescence and adulthood and placing significant social and emotional burdens on their direct environment. Children with congenital heart disease face both direct and indirect challenges related to their disease. These challenges are most likely to be the source of poor school performance and learning, as suggested by the literature. Close monitoring, early interventions, and multidisciplinary care are essential to address these vulnerabilities and improve educational outcomes in children with congenital heart disease.

A Comparison of the Effects of Sevoflurane, Propofol, and Propofol Combined with Butorphanol in Suppressing Sufentanil-Induced cough-A Randomized Controlled Trial

Objective

To study the safety and efficacy of sevoflurane pretreatment in preventing sufentanil-induced cough in children and to compare its antitussive effect with that of butorphanol, an opioid analgesic that has been proven effective in clinical trials.

Data and Methods

This was a prospective randomized controlled trial. A total of 174 patients who underwent ENT surgery at Chaohu Hospital Affiliated with Anhui Medical University were enrolled and divided into groups S, C and B, with 58 patients in each group, according to the random number table method. General anesthesia was induced with 5% sevoflurane in Group S, 2.5 mg/kg of propofol and 30 μg/kg of butorphanol in Group B, and 2.5 mg/kg of propofol and 1 mL of normal saline in Group C. The cough grade, intraoperative hemodynamic data, blood oxygen saturation, and adverse reactions within 24 h after the operation were recorded.

Results

The overall cough grade significantly differed among the 3 groups (P<0.05). Compared with those of Group C, the cough grades of Groups S and B were significantly lower (P<0.05). There was no significant difference in the cough grade between Group S and Group B (P>0.05). Groups S and B cannot be considered equivalent. There were no significant differences in the MAP, HR, SpO2 or BIS value among the three groups at different time points (P>0.05). There was no significant difference in the incidence of postoperative nausea, vomiting, dizziness or chills among the 3 groups (P>0.05).

Conclusion

Induction of anesthesia using 5% sevoflurane to reduce Bis to 60 in children significantly reduces the probability of sufentanil-induced coughing (SIC) without significant hemodynamic fluctuations.

Effect of Short-term Deep Breathing Exercises on Perioperative Anxiety and Pain in Pediatric Orthopedic Patients: A Randomized Controlled Trial

PURPOSE

There are currently no pediatric studies examining the effects of deep breathing on perioperative pain and anxiety. This study sought to determine the effect of short-term deep breathing exercises on perioperative anxiety and pain in pediatric patients and their parents.

DESIGN

A randomized controlled trial was conducted in the Department of Orthopaedic Surgery where pediatric patients about to undergo surgery were allocated to a control group or a deep breathing group. In the intervention group, patients and their main guardian were guided to practice 10 minutes of deep breathing exercises twice a day for 3 to 4 days prior to surgery. Perioperative anxiety and pain were measured for both the children and parents as outcome indicators.

METHODS

Perioperative anxiety was measured using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) and state anxiety was measured using the State-Trait Anxiety Inventory (STAI). Patients reported their pain levels daily using the Wong-Baker FACES Pain Rating Scale. The following cutoffs were determined as high levels of anxiety: STAI (adult) > 44, STAI (child) > 36, and mYPAS-SF ≥ 30.

FINDINGS

No significant differences were found in the STAI, mYPAS-SF, and Wong-Baker FACES Pain Rating Scale scores of the patients between the intervention and control group. Overall statistics showed that parents had significantly higher postoperative state anxiety levels toward female children (44.93 ± 9.01) compared to male children (40.18 ± 9.89). Preoperative and postoperative parental state anxiety levels were correlated with the child's postoperative anxiety. Furthermore, children's postoperative state anxiety was slightly correlated with postoperative pain.

CONCLUSIONS

Short-term use of our deep breathing exercises was ineffective in reducing incidences of perioperative pain and anxiety in pediatric orthopedic patients. A longer period of deep breathing administration may be required for the intervention to be effective. Parental anxiety may have an effect on anxiety levels in children, and postoperative parental anxiety may be affected by the gender of the child.

Preoperative Anxiety Management Practices in Pediatric Anesthesia: Comparative Analysis of an Online Survey Presented to Experts and Social Media Users

Background

Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological and nonpharmacological interventions are used to reduce children's anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. Health care professionals using social media as a source of medical expertise may offer insights into their management approaches.

Objective

A public survey targeting health care professionals was disseminated via social media platforms to evaluate current practices in anxiety management in children. The same questions were posed during an annual meeting of pediatric anesthesiologists with their responses serving as reference. The primary objective was to compare pediatric anesthesia expertise between the groups, while secondary objectives focused on identifying similarities and differences in preoperative anxiety management strategies hypothesizing expertise differences between the groups.

Methods

Two surveys were conducted. The first survey targeted 100 attendees of the German Scientific Working Group on Pediatric Anesthesia in June 2023 forming the "Expert Group" (EG). The second open survey was disseminated on social media using a snowball sampling approach, targeting followers of a pediatric anesthesia platform to form the "Social Media Group" (SG). The answers to the 24 questions were compared and statistically analyzed. Questions were grouped into 5 categories (pediatric anesthesia expertise, representativity, structural conditions, practices of pharmacological management, and practices in nonpharmacological management).

Results

A total of 194 responses were analyzed (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs 10 y, P<.001), higher specialist status (97.6% vs 64.6%, P<.001), and a greater pediatric anesthesia volume (43.9% vs 12% with more than 500 cases per year, P<.001). Regarding the representativity, 2 items out of 4 were statistically significant (level of care of institution, annual caseload of institution). Regarding the overall anxiety management practices used, there is a heterogeneous response pattern within both groups.

Conclusions

Despite heterogeneous approaches, health care professionals using social media demonstrated less expertise in pediatric anesthesia but showed minimal differences in the daily management of preoperative anxiety compared with pediatric anesthesia experts. Our study highlights the potential for meaningful use of social media but future studies should explore the impact of social media health care professionals' knowledge in other specific topics. Additionally, regarding preoperative anxiety, further recommendations are needed that could help to standardize and improve anxiety levels in children.

Analysis of the Effect of Early Intensified Follow-Up on the Treatment of Pediatric Flatfoot With Subtalar Arthroereisis

As children are a special group, the optimal management approach for pediatric patients with flatfoot after subtalar arthroereisis remains unclear. This study aims to explore the clinical effects of early intensified follow-up compared to conventional follow-up for such patients. We conducted a prospective study on 83 pediatric flatfoot patients from January 2019 to June 2022. Patients were divided into early intensive follow-up and routine follow-up groups. The study compared preoperative, 3 months postoperative, and 1-year postoperative Maryland Foot Function Scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, and Visual Analogue Scale (VAS) scores, etc. At 3 months postoperatively, the early intensified follow-up group showed significantly higher Maryland Foot Score and surgery satisfaction compared to the conventional follow-up group. There were no statistical differences in other indicators at 3 months postoperatively, and all observed indicators at 1 year postoperatively. In conclusion, early intensive follow-up can accelerate the functional recovery process of pediatric flatfoot patients undergoing subtalar arthroereisis and improve surgical satisfaction. Increasing medical resource investment for enhanced postoperative management is valuable for such patients.

'Preoperative information helps my child and I experience less anxiety and fear': A grounded study examining parents' opinions and expectations

PURPOSE

This study aimed to investigate the opinions and experiences of parents whose children are hospitalized in a pediatric surgery clinic in Turkey regarding care practices.

DESIGN AND METHODS

Sixteen in-depth interviews with parents whose children were hospitalized in a pediatric surgery clinic were conducted and analyzed between October and December 2023, by grounded theory methodology. The COREQ guidelines guided the reporting of this study.

RESULTS

A core category was identified, 'Preoperative information helps my child and I experience less anxiety and fear' demonstrating that parents are aware of their situation. Analyzing resulted in an interpretive theory of two interrelated categories: 'Quality Nursing Care' and 'Patient and Parent Satisfaction'.

CONCLUSION

Children and parents who received accurate, sufficient, and timely information experienced less anxiety and fear in the preoperative. Quality nursing care significantly affects the well-being of parents and pediatric patients. As a result of all these, high patient and parent satisfaction is an important care outcome.

PRACTICE IMPLICATIONS

Reducing the anxiety and fears of pediatric patients and parents in the preoperative is an important goal. Quality nursing care is one of the most important perceived factors in achieving this goal. Providing in-service training on this subject can increase awareness, especially for nurses new to the pediatric surgery clinic.

Utility of interactive videogame in allaying preoperative anxiety in pediatric surgical patients - A randomized controlled study

INTRODUCTION

Non-pharmacological distraction using video games (VG) is still under-explored in pediatric surgical patients.

MATERIALS AND METHODS

We conducted this randomized controlled study of 150 children, aged 4-12 years, scheduled for elective surgery in a tertiary care hospital to estimate the distractive effect of VG on immediate preoperative anxiety in children. In the intervention group (I), playing with VG was encouraged till anesthetic induction. The control group (C) received usual care with verbal reassurance. Modified Yale preoperative anxiety scale (mYPAS) score and presence of anxiety (mYPAS >30) were noted in the preoperative area (T1), at parental separation (T2), and anesthetic induction (T3). Parental separation anxiety score (PSAS) >3 was considered unacceptable parental separation. We used the Mann-Whitney test and t-test to find significance of intergroup mean difference of anxiety and logistic regression to find risk factors for immediate preoperative anxiety.

RESULTS

The mean m-YPAS (±SD) scores at T1 and T2 were 38 (±10.9) and 52.2 (±18.7) in group C and 46.5 (±13.5) and 33 (IQR: 28.3-65.5) in group I, respectively. The incidence of anxiety at T2 was higher in group C (81.3%) than in group I (59%). More children in group I (53/75) had acceptable separation than in group C (32/75) (P = 0.001). VG led to a 2.32 times lower risk of anxiety at T2 (P = 0.036). In children with acceptable separation, the incidence of anxiety was lower in group I (59%) than in group C (87%).

CONCLUSION

VG-based distraction effectively reduced preoperative anxiety in children undergoing elective surgeries.

Exploring Preoperative Experiences and Informational Needs Among Chinese School-Age Children Undergoing Elective Surgery: A Qualitative Study

AIM

To understand preoperative experiences and information needs of Chinese school-aged children undergoing elective surgery to design standardized preoperative education programs to alleviate preoperative anxiety.

METHODS

Semi-structured interviews combined with drawing, writing, and telling techniques were conducted in 12 children. The paintings were interpreted alongside children's verbal expressions. All data were analyzed using thematic analysis.

RESULTS

Three themes emerged: Origins of Surgical Knowledge: Proximity-based knowledge, media exposure, past personal medical experiences, ward-mate interactions, healthcare staff education; Pre-Surgery Experiences: Anticipation of pain, post-op sensations and impact on life, fantasizing about the operation, being aware of risks, demonstrating psychological resilience, being curious about anesthesia experience, enjoying a break; Preoperative Informational Needs: 55 identified.

CONCLUSIONS

Lack of standardized preoperative education creates a gap between children's knowledge and actual surgical experiences. Developing preoperative education tailored to individualized informational needs and developmental level helps fill their gaps, alleviate preoperative anxiety and improve health outcomes.

3-Dimensional Virtual Reality Versus 2-Dimensional Video for Distraction During the Induction of Anesthesia in Children to Reduce Anxiety: A Randomized Controlled Trial

BACKGROUND

Preoperative anxiety is common in children. It can contribute to negative experiences with anesthetic induction and may cause adverse physiological and psychological effects. Virtual reality (VR) and electronic tablet devices are 2 audiovisual distraction tools that may help to reduce anxiety and enhance the preoperative experience. This study aimed to compare the use of an immersive 3-dimensional (3D) VR to 2-dimensional (2D) video on anxiety in children during induction of general anesthesia.

METHODS

Two hundred children (4-13 years) undergoing elective or emergency surgery under general anesthesia were enrolled in this randomized, controlled trial. Participants were randomized to use either the 3D VR goggles (intervention) or 2D video tablet (control) during anesthetic induction. Anxiety, the primary outcome, was measured using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) at 2 time points: in the preoperative holding area before randomization (T1) and during induction of general anesthesia (T2). The primary outcome was analyzed using a linear regression model, including demographic and other covariates, to investigate any differences in anxiety scores. Secondary outcomes included evaluating compliance during the anesthetic induction (Induction Compliance Checklist), emergence of delirium (Cornell Assessment of Pediatric Delirium), perceived usefulness of the device, and child satisfaction.

RESULTS

Participant characteristics were similar between the 3D VR (n = 98) and 2D video (n = 90) groups, with a mean (±standard deviation) age 8. 8 ± 2.8 years. The median (lower quartile, upper quartile) mYPAS-SF scores for the 3D VR group at the preoperative holding area were 22.9 (22.9, 35.4), then 29.2 (24.0, 41.7) during induction. For the 2D Video group, the scores were 27.1 (22.9, 35.4) and then 30.2 (22.9, 41.1). No significant difference was observed in the increase in mYPAS-SF scores between groups (P = .672). Children in the 3D VR group were less likely to be rated as having a perfect induction (P = .039). There was no evidence of a difference between the groups in emergence delirium. Both devices were rated highly for usefulness and patient satisfaction. Children preferred VR, while anesthesiologists and parents felt the 2D was more useful.

CONCLUSIONS

This randomized controlled trial demonstrated that preoperative anxiety was equally low and induction compliance high with both 3D VR and 2D video distraction in children with parental presence during anesthetic induction.

Effect of Alleviating Preoperative Anxiety on Gastrointestinal Function Recovery After Laparoscopic High Ligation of the Hernia Sac in Children with Indirect Inguinal Hernia

Purpose

Anxiety and depression can affect the physiology of the gastrointestinal tract through the brain-gut axis, causing gastrointestinal dysfunction, which is mainly manifested as indigestion, diarrhoea, constipation, or abdominal pain. Preoperative anxiety arises in children due to separation from parents, fear of unfamiliar surroundings and anaesthesia and surgical procedures.To discuss the effect of alleviating preoperative anxiety on postoperative recovery of gastrointestinal function in children with indirect inguinal hernia after laparoscopic high ligation of the hernia sac.

Patients and Methods

90 children with laparoscopic high ligation of the herniated sac in oblique inguinal hernia were randomly divided into control group (Group C) and experimental group (Group M). The Group M was given midazolam oral solution 0.5mg/kg (maximum dose 20mg), and The Group C was given 5% glucose solution with the same dose.Primary outcome was the time to first postoperative defecation and I-FEED scores.The secondary outcomes included mYPAS-SF scores; child sedation scores; child-parent separation scores; parental STAI scores;PHBQ scores;FLACC scores, operative time, and fluid input and surgeon job satisfaction.

Results

Compared with Group C, there was a shorter time to first postoperative defecation (P < 0.05), and lower I-FEED scores on postoperative day 1 (P < 0.05). The mYPAS-SF scores, which were significantly different in Group M at T1, T2, and T3 (P < 0.05), parental STAI scores at S1, child sedation scores and child-parent separation scores in T1, and surgeon job satisfaction between the two groups were significantly different (P < 0.05). There were no statistically significant differences in I-FEED scores on days 2 and 3, PHBQ scores, FLACC scores, operative time, and fluid input between the two groups of children (P > 0.05).

Conclusion

Preoperative application of midazolam oral solution to relieve preoperative anxiety helps to promote the recovery of postoperative gastrointestinal function in children with indirect inguinal hernia and increases the surgeon job satisfaction.

Effect of short film video and video-based education on fear, pain, and satisfaction of children undergoing day surgery

PURPOSE

This study aims to determine the effect of introducing the operating room environment with different informative multimedia methods to pediatric patients aged 7-12 in the preoperative period in day surgery on fear, pain, and patient satisfaction in three different groups comparatively.

DESIGN AND METHODS

This randomized controlled study was conducted with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). The sample of children was allocated to the Short Film Group (n:30), Video Based Education Group (n:30) and Control Group (n:30). Fear, pain, and satisfaction were measured.

RESULTS

The age distribution of the children in the study was 7.57 ± 1.25 years in the short film group, 7.27 ± 0.52 years in the video-based education group, and 7.57 ± 2.27 years in the control group. There was no significant difference between the groups in terms of demographic status, fear, and vital signs before the procedure. Fear, pain, and satisfaction levels of children in short film groups were lower than video-based education groups.

CONCLUSION

The result of this research reveals that preoperative short film education in children is more effective than video-based education in reducing fear, pain, and satisfaction levels. This intervention could be an effective method to improve outcomes. Nurses can increase children's comfort by using educational programs that attract children's attention.

PRACTICE IMPLICATIONS

Healthcare team members working in pediatric surgical units can use the short film method, which is effective, easy, and applicable in the field, to reduce pain and fear in the preoperative period and increase satisfaction in children undergoing day surgery.

Comparative Analysis of Intellectual Quotient in Developmental Population with Severe Hearing Loss: Hearing Aids vs. Cochlear Implant Users

The development of language, memory and intellectual functions is linked to normal hearing and correct sounds interpretation. Hearing loss (HL), especially in its severe form, negatively affects the development of these functions. This prospective study aimed at comparing the Intelligent Quotients (IQ) of children with cochlear implants (CI) with the ones of people wearing hearing aids (HA) after one year of hearing rehabilitation. 21 subjects with severe/profound bilateral hearing loss (deafness) were included in this study. Eleven children with congenital profound HL underwent CI and ten children with moderate to severe HL (congenital and acquired) were rehabilitated by HA. Children's IQs were assessed at enrolment (T0) and 12 months after hearing aids/CI use plus speech therapy. Statistical analyses were performed to analyze the data within and between groups. Comparison of IQs showed no statistically significant differences between CI and HA none at T0 and T1. The subtests showed lower scores in verbal comprehension and process speed index in patients treated with HA when compared to CI. This study showed that auditory rehabilitation can support the normal development of cognitive function in children between six and eight years of age. The use of the correct hearing aids based on the patient's hearing thresholds is important to maximize the rehabilitation outcomes. Due to the small sample size, although stratified for age, our results must be considered preliminary and further analyses on larger samples are needed to confirm our data.

Understanding School Anxiety in Italian Adolescence through an Artificial Neural Network: Influence of Social Skills and Coping Strategies

School anxiety depends on multiple factors that occur directly or indirectly in the teaching-learning process, such as going to the blackboard in class or reporting low grades at home. Other factors that influence school climate are social skills and coping strategies. That said, the aim of this research was to analyze the sources of school anxiety, coping strategies, and social skills in Italian secondary school students through an artificial neural network. For this purpose, a quantitative and ex post facto design was used in which the Inventory of School Anxiety (IAES), the Coping Scale for Children (EAN), and the Questionnaire for the Evaluation of Social Skills student version (EHS-A) were administered. The results showed that cognitive avoidance and behavioral avoidance coping strategies, together with the lack of social skills in students, are the variables that contributed the most to school anxiety scores in the artificial neural network. The conclusions revolve around the need to develop primary prevention programs.

Is Preoperative Anxiety Affected by Watching Short Videos on Social Media? A Prospective Randomized Study

PURPOSE

The purpose of this study was to investigate the impact of watching short videos in the preoperative waiting room on preoperative anxiety in children.

DESIGN

This study was designed as a prospective, randomized trial including 69 ASA I-II patients aged 5 to 12 years who were scheduled for elective surgery.

METHODS

The children were randomly allocated to two groups. The experimental group browsed short videos on a social media platform (eg, YouTube short, TikTok, Instagram reels) for 20 minutes in the preoperative waiting room, but the control group did not. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) at different time points: on arrival in the preoperative waiting room (T1), right before being taken to the operating room (OR) (T2), on entering the OR (T3), and during anesthesia induction (T4). The primary outcome of the study was children's anxiety scores at T2.

FINDINGS

The mYPAS scores at T1 were similar in both groups (P = .571). The mYPAS scores at T2, T3, and T4 were significantly lower in the video group than in the control group (P < .001).

CONCLUSIONS

Watching short videos on social media platforms in the preoperative waiting room lowered preoperative anxiety levels in pediatric patients aged 5 to 12.

Prevalence of preoperative anxiety among hospitalized patients in a developing country: a study of associated factors

BACKGROUND

Preoperative anxiety is a health concern among patients scheduled for surgical interventions. Little is known about the prevalence of preoperative anxiety among patients in different healthcare systems of developing countries. This study was conducted to determine the prevalence of preoperative anxiety among patients undergoing surgery in Palestine. Another objective was to identify the factors associated with preoperative anxiety.

METHODS

This study was conducted in a cross-sectional descriptive design. Patients scheduled for surgical interventions were interviewed using an interviewer-administered questionnaire. The questionnaire collected the demographic, clinical, and surgical variables of the patients. The questionnaire also contained the Amsterdam preoperative anxiety and information scale (APAIS), and a short version of the Spielberger state-trait anxiety inventory (STAIS-5/STAIT-5).

RESULT

A total of 280 patients were included. The mean APAIS total score was 13.6 ± 5.9, the mean APAIS anxiety domain score was 8.3 ± 4.3, and the mean APAIS need for information domain was 1.6 ± 0.50. Of the patients, 76 (27.1%) had high anxiety and 160 (57.1%) expressed a high need for information. The higher APAIS anxiety scores were predicted by being female, having chronic diseases, being scheduled to be operated on within 24 h, and having experienced surgical complications. The mean STAIS-5 score was 10.0 ± 4.2 and the mean STAIT-5 was 10.3 ± 3.8. Of the patients, 140 (50.0%) had high state anxiety and 56 (20.0%) had high trait anxiety. Higher STAIS-5 scores were predicted by being female, younger than 42 years, and scheduled to be operated on within 24 h. Higher STAIT-5 scores were predicted by being female. A positive correlation was identified between APAIS total, APAIS anxiety, APAIS need for information, STAIS-5, and STAIT-5 scores.

CONCLUSION

Preoperative anxiety was prevalent among patients scheduled for surgical operations in Palestinian hospitals. Anesthesiologists and other providers of perioperative care should screen preoperative patients who are female, have chronic diseases, are scheduled to be operated on within 24 h, and having had experienced surgical complications for preoperative anxiety. More studies are still needed to investigate the effects of the implemented measures on the prevalence of preoperative anxiety.

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

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

Effect of oral esketamine on preoperative sedation and venipuncture analgesia in pediatric patients: a prospective randomized double-blind controlled clinical trial.. [DOI: 10.21203/rs.3.rs-2323639/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Anxiety and uncooperation are common among pediatric patients during the preoperative preparation, which requires adequate and appropriate analgesia and sedation. Methods We performed a prospective, randomized, double-blind, controlled clinical trial involving 1–6-year-old pediatric patients scheduled for elective tonsillectomy or adenoidectomy between December 2020 and May 2021. Patients were randomly assigned to control (group C), esketamine 1 mg.kg− 1 (group EK1), or esketamine 2 mg.kg− 1 (group EK2) group. Venipuncture analgesia, cooperation, and sedation, as well as satisfaction upon parent–child separation, cooperation, sedation, and adverse events, were compared among the three groups. Dynamic changes in the sedation score and vital signs were monitored. Results A total of 88 pediatric patients were analyzed, with 29, 29, and 30 patients in groups C, EK1, and EK2, respectively. Compared with group C, groups EK1 and EK2 both had better analgesia during venipuncture (P < 0.001). In addition, better cooperation and sedation was noticed in groups EK1 and EK2 during parent–child separation and venipuncture than in group C. Compared with the baseline, the mean respiratory rate had a significant decrease from 25.6 ± 0.3 to 24.6 ± 0.4 breaths/min at 30 min after the esketamine administration in group EK2, although it was still within normal limits (P = 0.030). There were no significant differences in adverse events among three groups. Conclusions Preoperative oral administration of 1 or 2 mg.kg− 1 esketamine in pediatric patients could achieve effective analgesia and sedation. Oral medication of 2 mg.kg− 1 esketamine had more pronounced effects. Trial registration : This clinical trial was registered at the Chinese Clinical Trial Registry (ChiCTR2000040739) on 08/12/2020.

Factors Related to Anxiety in Paediatric Patients and Their Parents before and after a Modified Ravitch Procedure-A Single-Centre Cohort Study

OBJECTIVE

To assess the factors related to perioperative state anxiety in paediatric patients and their parents.

METHODS

A cohort study was conducted on paediatric patients 9-17 years of age, who underwent the modified Ravitch procedure (n = 96), and their parents (n = 96). The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Multivariable linear regression models were calculated to find the relationships between the pre- and postoperative state anxiety of the patients/parents and the independent variables, both demographic (age, gender) and clinical (e.g., postoperative pain, trait anxiety).

RESULTS

Preoperative anxiety in the paediatric patients was positively correlated with their trait anxiety (β = 0.47; 95% CI: 0.29 to 0.64) and preoperative parental anxiety (β = 0.24; 95% CI: 0.07 to 0.42). The high level of preoperative anxiety (vs. low and moderate) (β = 0.40; 95% CI: 0.22 to 0.58), trait anxiety (β = 0.22; 95% CI: 0.04 to 0.40) and average postoperative pain at rest (β = 0.18; 95% CI: 0.01 to 0.34) had a positive impact on the postoperative anxiety in patients. However, the patients' age was negatively correlated with postoperative anxiety (β = -0.19; 95% CI: -0.35 to -0.02). Three variables were found to predict preoperative parental anxiety: their trait anxiety (β = 0.41; 95% CI: 0.23 to 0.59), female gender (β = 0.18; 95% CI: 0.002 to 0.36) and the intravenous route for the postoperative pain management in the patients (β = -0.18; 95% CI: -0.36 to -0.001). The parental postoperative anxiety was influenced by their trait anxiety (β = 0.24; 95% CI: 0.04 to 0.43), preoperative anxiety in patients (β = 0.21; 95% CI: 0.02 to 0.40) and female gender of children (β = 0.19; 95% CI: 0.001 to 0.39).

CONCLUSIONS

Trait anxiety was a strong factor positively affecting the perioperative state anxiety. In addition, paediatric patient anxiety before surgery was related to their parents' anxiety, and, after surgery, this was associated with high preoperative anxiety, pain and age. The parents' anxiety before surgery was influenced by gender and the type of postoperative analgesia in the patients, while, after surgery, this was influenced by the patients' preoperative anxiety/gender.