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
-Route given: oral > nasal> IM > rectal
Medication % usage/ route options & dose:
PO (0.5 mg/kg), nasal/sublingual (0.2–0.3 mg/kg), rectal (0.5-1 mg/kg)
PO (5-6 mg/kg), IM (2-5 mg/kg), nasal(3-5 mg/kg), rectal (5-6 mg/kg)
PO (10–15 mcg/kg), IV (2 mcg/kg)
Nasal (3 mcg/kg), IV (0.5-1 mcg/kg)
PO (4-6 mcg/kg)
- 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
Work with children pre-op to reduce incidence of anxiety
Give parents and children an idea of what to expect on the day of surgery and reduce anxiety
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- Kain ZN, Mayes LC, O’Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996 Dec;150(12):1238-45.
- McCann ME, Kain ZN. The management of preoperative anxiety in children: an update. Anesth Analg. 2001 Jul;93(1):98-105.
- Visintainer MA, Wolfer JA. Psychological preparation for surgery pediatric patients: the effects on children’s and parents’ stress responses and adjustment. Pediatrics. 1975 Aug;56(2):187-202.
Defined by: Catherine Ray, MD