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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


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