High Anxiety, Young Age and Long Waits Increase the Need for Preoperative Sedatives in Children

Abstract

OBJECTIVE:This prospective, observational study aimed to identify children likely to require sedation preoperatively by measuring anxiety levels using the modified Yale Preoperative Anxiety Scale (mYPAS). Other possible predictive factors for preoperative sedation were also investigated. METHODS: A total of 455 patients aged 2 -12 years scheduled for surgery requiring general anaesthesia were enrolled in the study. Patients' anxiety levels were measured using the mYPAS in a preoperative holding area just before patients were separated from their parents or guardians and entered the operating theatre. Anaesthetists blinded to the mYPAS assessments judged whether the child could be separated and enter the operating theatre without a sedative. The ability of the mYPAS to predict the need for preoperative sedation was analysed by receiver operating characteristic (ROC) curve analysis. RESULTS: The optimum mYPAS cut-off for requiring sedatives was 41.7 according to ROC curve analysis. Multivariate logistic regression analysis showed that age, mYPAS > 40 and waiting time were independent predictors of the requirement for sedative administration. CONCLUSIONS: High anxiety levels, young age and long waits contributed to the need for preoperative sedation in children.

Parameters of anesthesia/sedation in children receiving radiotherapy

“…These data are consistent with limited data in the anesthesia literature assessing pre-operative anxiety. In a prospective study by Kim and associates [9], age, type of parent or guardian, number of siblings, waiting time and score on the modified Yale Preoperative Anxiety Scale (mYPAS) were assessed for predicting need for pre-operative sedation for anxiety in children prior to general anesthesia (GA). In multivariate analysis, age, mYPAS score and waiting time were significant factors related to anxiety levels requiring preoperative sedation.…”

<p>Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study</p>

“…This is consistent with the findings from previous literature. 34,38 In children, the perception of anxiety depends on the developmental stage and cognitive potential of the child; different responses can be observed among those facing the same stressor agent. With increasing age, the cognitive capacity of the child increases, resulting in more awareness, understanding, and more likely to overcome stress than younger children.…”

“…33,40 On the contrary, other studies showed that children with previous surgery and anesthesia were significantly less anxious during the preoperative period. 37,38 The possible explanation for this may be children who had previous negative surgical and anesthetic histories (who suffer pain, light anesthesia) may exacerbate subsequent anesthesia and surgery-related anxiety. However, those who had a previous positive and smooth experience of previous surgeries may favor the sense of safety in the child because he/she already knows what to expect; they are dealing with something known, about the surgery and anesthesia which may attenuate anxiety in the subsequent surgery.…”

“…In contrast to our result children enrolled in outpatient surgery have been reported to be less anxious than inpatients. 33,38 The variation can be due to the time spent at the hospital is reduced and the opportunities of the healthcare professionals to provide information to children and their parents are limited. 10 Another possible explanation for this finding could be due to the commonest practice of intraveins anesthetic induction in our set-up, children scheduled for outpatient surgery are cannulated in the waiting room without the use of topical anesthetics before the entrance to the operation room which may increase fear of harming the operation room.…”

Behavioral Changes in Children After Emergency Department Procedural Sedation

“…Based on prior literature, children were categorized into the high anxiety group if their score was 40 or greater. 13…”