Postoperative Maladaptive Behavior, Preoperative Anxiety and Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review

Abidin, Huda Zainal; Omar, Sanihah Che; Mazlan, Mohd Zulfakar; Hassan, Mohd Hasyizan; Isa, Ruwaida; Ali, Saedah; Hassan, Shamsul Kamalrujan; Marzuki, Azizan

doi:10.1177/2333794x211007975

Cited by 19 publications

(14 citation statements)

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“…The results show that there is no protocol or preparation program for parents and children who will undergo outpatient surgery in the hospital studied. These preparation programs, suggested by the nurses studied, have already been pointed out in the literature as one of the aspects that would reduce the levels of anxiety in parents and children on the day of the surgical intervention 33 and would save time in the surgical process 34 .…”

Section: Discussionmentioning

confidence: 96%

Nursing evaluation of pediatric preoperative anxiety: a qualitative study

Molina

Valls

Villegas

et al. 2023

Rev. Latino-Am. Enfermagem

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Objective: to explore and describe how perioperative nurses assess and interpret the child’s behavior before entering the operating room, identifying the strategies they use to reduce anxiety and the proposals for improvements. Method: descriptive qualitative study using semi-structured interviews and participant observation of daily routines. Thematic analysis of data. This study follows the recommended criteria for publication of articles of the qualitative methodology Consolidated Criteria for Reporting Qualitative Research. Results: four topics emerged from the data: a) assessment of anxiety or close communication with the child and their family; b) evaluating what was observed; c) managing anxiety and d) improving the assessment or proposals for improvements in daily practice. Conclusion: nurses assess anxiety in their daily practice through observation using their clinical judgment. The nurse’s experience is decisive for the appropriate assessment of the preoperative anxiety in child. Insufficient time between waiting and entering the operating room, lack of information from child and their parents about the surgical procedure, and parental anxiety make it difficult to assess and properly manage anxiety.

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Section: Discussionmentioning

confidence: 96%

Nursing evaluation of pediatric preoperative anxiety: a qualitative study

Molina

Valls

Villegas

et al. 2023

Rev. Latino-Am. Enfermagem

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“…There is a high incidence of significant anxiety in the perioperative pediatric population. 1 Up to 60% of all young children undergoing anesthesia and surgery report significant preoperative anxiety, 2 with an incidence of post-anesthesia delirium and behavioral changes in 20%-80% 3 and 50%, respectively. 4 The induction of anesthesia and the moment of separation from parents are the most stressful experiences for a child who must undergo a surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Children who are highly anxious before surgery have significantly higher postoperative pain, delayed hospital discharge, higher incidence of emergence delirium, sleep disturbances, and other maladaptive behavioral changes that last up to a few weeks following surgery. 1,2 Some children with preoperative and, or postoperative anxiety have nightmares, negative behaviors, separation anxiety, or nocturnal enuresis up to 6 months after surgery. 6 Various pharmacological and non-pharmacological interventions have been designed to minimize perioperative anxiety and reduce the side effects, such as nightmares.…”

Section: Introductionmentioning

confidence: 99%

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Effects of virtual tour on perioperative pediatric anxiety

Castanys

Carrión

Gómez

et al. 2023

Pediatric Anesthesia

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Background: There is a high incidence of perioperative anxiety in the pediatric population, with adverse side effects, such as emergency delirium and maladaptive postoperative behaviors.Aims: The study's objective was to compare the level of preoperative anxiety in children after standard preparation plus a virtual tour of the operating room vs. standard preparation alone.Patients/Methods: This was a prospective single-center, randomized, controlled, blinded trial with parallel assignment, registered as NCT04043663. Eligible subjects were healthy children (ASA I-II) aged 4-12, scheduled for outpatient surgery. Five visits were conducted during the study, two at the hospital and three over the phone. Variables assessed were child's anxiety through the modified Yale Perioperative Anxiety Scale, demographic data, cooperation with induction through the Induction Compliance Checklist, preoperative parental anxiety through the State-Trait Anxiety Inventory and Anxiety Visual Analog Scale, the postoperative delirium degree through the Pediatric Anesthesia Emergence Delirium Scale, the presence of behavioral changes through the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery, and the overall parental satisfaction.Results: A total of 125 participants were included; 61 (48.8%) of them were randomized to the Virtual Tour Group (VT+) and 64 (51.2%) to the Non-virtual Tour Group (VT-). Yale Preoperative Anxiety Scale results in VT+ vs. , (p = .0086).In the VT+ group, satisfaction was higher for questions one (p = .0213), three (p = <.0001), and four (p = .0130). Throughout the study, we observed a significant reduction in perioperative anxiety in the VT+ group, facilitating anesthetic induction in perfect (p = .018) and moderate compliance (p = .0428). The other variables did not show statistically significant differences. Conclusion:Our study confirms previous studies that found virtual tours for perioperative patients may reduce perioperative anxiety and improve satisfaction. We found no impact on longer-term outcomes.

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“…An unpleasant surgical or anesthesia experience, younger age, short preoperative preparation time, and parental anxiety are all risk factors for preoperative anxiety in children [3,4]. Negative behaviors including separation anxiety, nightmares, aggression toward authorities, nocturnal enuresis, and eating disorders, can all increase preoperative anxiety in children, which also increases the postoperative analgesic requirements, prolongs the postoperative recovery process, induces emotional trauma in children and their parents, or affects the long-term cognitive and emotional development of children [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Effect of interactive, multimedia-based home-initiated education on preoperative anxiety inchildren and their parents: a single-center randomized controlled trial

et al. 2023

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Background Anesthesiologists need to appreciate the impact of preoperative anxiety in children. The present study aimed to explore whether interactive multimedia-based home-initiated interventions could effectively relieve preoperative anxiety in pediatric patients. Methods In this prospective study, we compared preoperative anxiety between two groups of children aged 4–9 years. Children in the control group received a question-and-answer (Q&A) introduction, and children in the intervention group received multimedia-based home-initiated preoperative education using comic booklets, videos, and coloring game books. Differences in anxiety between the two groups were evaluated by the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) at four time points: in the ophthalmology outpatient clinic before intervention as the baseline (T0); in the preoperative waiting area (T1); at the time of separating from their parents and moving to the operating room (T2); and at the time of anesthesia induction (T3). Parental anxiety was assessed by the Self-rating Anxiety Scale (SAS) and Visual Analog Scale (VAS) at T0 and T2. Other related information was collected by questionnaire. Results Eighty-four children who underwent pediatric strabismus in our center between November 2020 and July 2021 were included in this study. An intention-to-treat (ITT) analysis was performed on data from 78 enrolled children. Children in the intervention group exhibited lower m-YPAS-SF scores at T1, T2, and T3 than those in the control group (all p < 0.001). By using a mixed-effect model with repeated measurement (MMRM) after adjusting the m-YPAS score at T0 as a covariate, the interventional effect in terms of themYPAS-SF score was also significant over time (p < 0.001). The percentage of children with perfect induction compliance (ICC = 0) in the intervention group was significantly higher than that in the control group [18.4% vs. 7.5%], and poor induction compliance (ICC>4) was lower (2.6% vs. 17.5%, p = 0.048). The mean parental VAS score at T2 in the intervention group was significantly lower than that in the control group (p = 0.021). Conclusions Interactive multimedia-based home-initiated intervention could reduce preoperative anxiety in children and improve the quality of anesthesia induction based on ICC scores, which may in turn impose a positive impact on parental anxiety.

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Postoperative Maladaptive Behavior, Preoperative Anxiety and Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review

Cited by 19 publications

References 50 publications

Nursing evaluation of pediatric preoperative anxiety: a qualitative study

Nursing evaluation of pediatric preoperative anxiety: a qualitative study

Effects of virtual tour on perioperative pediatric anxiety

Effect of interactive, multimedia-based home-initiated education on preoperative anxiety inchildren and their parents: a single-center randomized controlled trial

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