Measurement in Management of Anxiety in Children for Open Heart Surgery

Abstract

A study of neuro-endocrine and behavioral response to psychological stress of 11 children having heart surgery was initiated. An attempt was made to learn if more overtly anxious children would respond differently during hospitalization and surgery than those who appeared to have better emotional control. All children in this study survived the surgery. It is suggested that prognosis is greatly related to the coping capacity of a child and his family to stress; that prognoses can be predicted if adequate assessments can be made; and that as more precise methods for evaluation of the neuro-endocrine response become available it will be useful to employ them to explore the complicated relationship between the central nervous system and the endocrine organs in relation to children under stress. Assessment of anxiety in affect and function was made by a child psychiatrist and a pediatric nurse specialist during the hospitalization and at outpatient follow-up. Twenty-four-hour urine collections were made after suture removal and pre- and post-discharge and analyzed for 17-hydroxycorticosteroids by a modification of the method of Porter and Silber. In terms of emotional stimulation of the adrenocortical axis, the days before surgery and of return from intensive care were the most stressful of the days studied. The mean value on the day before surgery was significantly greater than that on the day before discharge. Values for the day before and after suture removal were also elevated in comparison with the day before discharge. Hospitalization was seen as stressful in terms of the parameter studied with the mean of all inpatient values including the day of discharge being approximately double that obtained by pooling all outpatient determinations. Surprising to the researchers was the fact that no difference was found between values for overtly excessively anxious children versus their less anxious counterparts on specific days, or when pooled in-hospital values were contrasted. The degree of elevation of 17-OHCS was related to the situation. No correlation between our estimate of anxiety and 17-OHCS levels was found.