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The epidemiology and selective identification of children at risk for preoperative anxiety reactions
1Department of Anesthesiology, Children's Hospital Medical Center of Akron, OH 44308.
Insights
Younger children (2-6 years) experience more distress during parental separation before surgery. Previous surgery and a withdrawn affect predict this anxiety in children, guiding targeted sedation strategies.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Surgical Patient Care
Background:
- Preoperative parental separation is a common source of anxiety in children.
- Understanding age and clinical factors predicting this anxiety is crucial for effective management.
Purpose of the Study:
- To evaluate the impact of age and gender on children's preoperative anxiety during parental separation.
- To identify clinical predictors of problematic preoperative behavior in children.
Main Methods:
- Prospective observational study of children in an outpatient setting.
- Assessment of children's behavior during preoperative parental separation.
- Analysis of age, gender, and five clinical factors as predictors.
Main Results:
- Children aged 2-6 years showed significantly more difficulty with parental separation than older children (7-8 years).
- Gender did not significantly affect separation anxiety.
- In younger children, prior surgery, not taking a family tour, and a withdrawn affect predicted problematic behavior.
Conclusions:
- Age is a key factor in preoperative separation anxiety, with younger children being more vulnerable.
- Specific clinical factors can identify children at higher risk for separation anxiety.
- Targeted sedation for high-risk children is recommended over routine sedation for all young patients.
Abstract:
This observational outpatient study was undertaken prospectively to assess the effect of age and gender on the frequency of children's difficulty with preoperative parental separation and to examine five simple clinical factors as predictors of problematic preoperative behavior. Although gender had no significant effect, 2- to 6-yr-old children were more likely than children 7 to 8 yr old to exhibit problematic behavior on parental separation (P < 0.05). In 2- to 6-yr-old children, three factors were significant predictors of problematic behavior: not taking a preoperative family tour (P < 0.05), having undergone previous surgery (P < 0.05), and preoperatively displaying a dependent or withdrawn affect (P < 0.05). Instead of implementing the routine use of a sedative, optimal management seems to involve sedating only 2- to 6-yr-old children who display one or more of these significant predictive risk factors.