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Preoperative preparation programs in children: a comparative examination
Z N Kain1, L A Caramico, L C Mayes
1Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA. kain@biomed.med.yale.edu
Insights
An extensive preoperative preparation program for children undergoing surgery reduced child and parent anxiety before the operation. However, this behavioral intervention did not significantly impact anxiety during anesthesia induction or postoperative recovery.
Area of Science:
- Pediatric Surgery
- Child Psychology
- Anxiety Management
Background:
- Preoperative anxiety in children and parents is a significant concern.
- Behavioral preparation programs aim to mitigate this anxiety.
- The effectiveness of extensive versus limited programs requires further investigation.
Purpose of the Study:
- To compare the efficacy of an extensive behavioral preparation program against a limited one for children undergoing surgery.
- To assess the impact on child and parent anxiety during the preoperative, intraoperative, and postoperative periods.
Main Methods:
- Randomized controlled trial involving 75 children aged 2-12 years.
- Three groups received varying levels of preparation: information-only, information + modeling, or information + modeling + coping skills.
- Anxiety was measured using behavioral and physiological indicators.
Main Results:
- Children in the extensive preparation group showed significantly reduced anxiety in the preoperative holding area on the day of surgery (P = 0.02).
- Parents in the extensive program also reported significantly lower anxiety preoperatively (P = 0.015 for behavioral, P = 0.01 for physiological measures).
- No significant differences in anxiety were observed during anesthesia induction, recovery, or two weeks postoperatively across groups.
Conclusions:
- An extensive preoperative behavioral preparation program can effectively reduce anxiety in children and parents before surgery.
- The anxiolytic effects appear localized to the preoperative period.
- The intervention did not demonstrate sustained benefits during or after the surgical procedure.
Unlabelled:
We sought to determine whether an extensive behavioral preparation program for children undergoing surgery is more effective than a limited behavioral program. The primary end point was child and parent anxiety during the preoperative period. Secondary end points included behavior of the child during the induction of anesthesia and the postoperative recovery period. Several days before surgery, children (n = 75) aged 2-12 yr randomly received either an information-based program (OR tour), an information + modeling-based program (OR tour + videotape), or an information + modeling + coping-based program (OR tour + videotape + child-life preparation). Using behavioral and physiological measures of anxiety, we found that children who received the extensive program exhibited less anxiety immediately after the intervention, in the holding area on the day of surgery, and on separation to the operating room. These findings, however, achieved statistical significance only in the holding area on the day of surgery (44[10-72] vs 32[8-50] vs 9[6-33]; P = 0.02). Similarly, parents in the extensive program were significantly less anxious on the day of surgery in the preoperative holding area, as assessed by behavioral (P = 0.015) and physiological measures (P = 0.01). In contrast, no differences were found among the groups during the induction of anesthesia, recovery room period, or 2 wk postoperatively. We conclude that children and parents who received the extensive preoperative preparation program exhibited lower levels of anxiety during the preoperative period, but not during the intraoperative or postoperative periods.
Implications:
The extensive behavioral preoperative program that we undertook had limited anxiolytic effects. These effects were localized to the preoperative period and did not extended to the induction of anesthesia or the postoperative recovery period.