Pediatric: Preoperative anxiety

Incidence: 60% Shown to be consistent regardless of country, procedure or health care system

Who is at greatest risk?

• Age > 7 years
• Personality: Children who are shy, inhibited, introverted are at increased risk
• Children who have anxious parents
• Prior upsetting hospital experience
• Only children (children without siblings)
• Children who did not attend pre-school

Why treat it?

• Anxiety can delay induction of anesthesia
• Hinder recovery
• Lasting detriment: Up to 10 % of children can have behavior problems up to 1 year after surgery

5 factors that provoke anxiety:

• Thoughts of physical harm/injury
• Separation from parents
• Fear of unknown
• Uncertainty about normal behavior
• Loss of control

Pharmacologic Management -Route given: oral > nasal> IM > rectal Medication % usage/ route options & dose:

Midazolam (85%)

• PO (0.5 mg/kg), nasal/sublingual (0.2–0.3 mg/kg), rectal (0.5-1 mg/kg)

Ketamine (4%)

• PO (5-6 mg/kg), IM (2-5 mg/kg), nasal(3-5 mg/kg), rectal (5-6 mg/kg)

Fentanyl (3%)

• PO (10–15 mcg/kg), IV (2 mcg/kg)

Dexmedetomidine (?)

• Nasal (3 mcg/kg), IV (0.5-1 mcg/kg)

Clonidine (?)

• PO (4-6 mcg/kg)

Non-Pharmacologic Management Parental presence

• Pros: Avoids the need for pre-operative sedatives, avoid separation anxiety
• Cons: Adverse parental reaction and litigation if injury ensues, anxious parents, stress on anesthesiologist/OR staff, less effective than Midazolam

Child life

• Work with children pre-op to reduce incidence of anxiety

Pre-op programs

• Give parents and children an idea of what to expect on the day of surgery and reduce anxiety