The Effect of Immersive Virtual Reality Application on Anxiety, Pain, and Parental Satisfaction in the Perioperative Process of Children: A Randomized Controlled Trial.

PURPOSE: To determine the effects of virtual reality (VR) interventions on pre- and postoperative anxiety, pain, and parental satisfaction in children. DESIGN: A randomized controlled trial. METHODS: Children undergoing surgery for the first time and their families were randomly assigned to the control or VR group. The control group received conventional education regarding the perioperative process. The VR group watched a VR video illustrating the operating theater and explaining the perioperative process. The primary outcome of interest was preoperative anxiety, evaluated using the Children's State Anxiety Scale. Secondary outcomes of interest included postoperative pain ratings using the Wong-Baker Faces Pain Rating Scale and parental satisfaction scores using the PedsQL Health Care Satisfaction Scale. RESULTS: The analysis included 70 children and their families (control = 35, VR = 35). Demographic characteristics were similar between the groups. Children in the VR group had significantly lower preoperative anxiety scores (p < .001) and postoperative anxiety scores (p = .010) compared to the control group. Parental satisfaction scores were significantly higher in the VR group (p < .001). The VR group had lower postoperative pain scores, but this difference was not statistically significant (p > .05). CONCLUSIONS: Preoperative education using VR tours may reduce preoperative anxiety and increase parental satisfaction. However, the lack of baseline measurements limits our ability to definitively attribute these effects to the VR intervention. Despite this, VR is a promising nonpharmacological strategy for managing children's anxiety and increasing parental satisfaction. CLINICAL IMPLICATIONS: Virtual reality interventions offer an effective nonpharmacological strategy for perioperatively managing children's anxiety and increasing parental satisfaction.

The Relationship Between Preoperative Anxiety Level and Postoperative Pain Outcomes in Total Hip and Knee Replacement Surgery: A Cross-sectional Study.

PURPOSE: Preoperative anxiety is considered a common part of the surgerical experience and can be associated with serious postoperative side effects. This study aims to determine the relationship between preoperative anxiety level and postoperative pain outcomes in patients undergoing total hip replacement (THR) and total knee replacement (TKR). DESIGN: The study used a cross-sectional and correlational research method. METHODS: The study was conducted with a total of 104 participants, who underwent 17 THR and 87 TKR, at the Orthopedic Clinic of a state hospital in southern Turkey between June 2021 and June 2022. The State-Trait Anxiety Inventory (STAI) was used to determine preoperative anxiety level, and the Visual Analog Scale (VAS) and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) were used to assess postoperative pain level. FINDINGS: The mean preoperative STAI-I and STAI-II scores of the participants who underwent THR and TKR were 53.95 ± 10.51 and 44.20 ± 10.55, respectively. There was a moderate positive correlation between STAI-I scores and VAS pain scores at preoperative and postoperative 6th, 12th, 24th, and 36th hours. There was a moderate positive correlation between STAI-I scores and affective subdimension scores, a moderate positive correlation with pain severity and sleep interference and activity interference, and a weak positive correlation between STAI-II scores and pain severity and sleep interference, activity interference and affective. The factors independently affecting the 6th-hour VAS pain score were determined as male gender, THR procedure, and increasing STAI score. CONCLUSIONS: We found that high preoperative state anxiety was associated with early postoperative pain outcomes. State anxiety was associated with pain in the 6th postoperative hour. Considering the multidimensional nature of anxiety, further research is recommended to understand the anxiety domain in surgical patients.

Virtual reality exposure reduce acute postoperative pain in female patients undergoing laparoscopic gynecology surgery: A Randomized Control Trial (RCT) study.

STUDY OBJECTIVE: Few studies have focused on the effect of virtual reality (VR) exposure on postoperative acute pain in adult female patients undergoing gynecology surgery. DESIGN: A randomized control trial (RCT) study. SETTING: At Beijing Fuxing Hospital. PATIENTS: 115 patients aged between 20 and 60 years, American Society of Anesthesiologists (ASA) physical status I - II were consecutively enrolled and randomly divided into VR group (n = 58) or control group (n = 57). INTERVENTIONS: Patients in the VR group received 15 min of VR video viewing before surgery. MEASUREMENTS: The primary outcome was acute postoperative pain at 8 h which was measured by the Visual Analogue Scale (VAS) scores. The secondary outcomes including the use of analgesic drugs, the incidence of moderate pain and postoperative recovery which were recorded 24 h after surgery. The Hospital Anxiety and Depression Scale (HADS) was also used to evaluate patients' emotional status before surgery. MAIN RESULTS: The VAS scores at 30 min [2 (1,2) vs. 3 (2,3)], 2 h [2 (2,3) vs. 4 (3,4)], 4 h [3 (2,4) vs. 4 (4,5)], 8 h [3 (2,4) vs. 4 (4,5)], 12 h [2 (2,3) vs. 4 (3,4)], 24 h [1 (1,2) vs. 3 (2,3)] after surgery. Generalized estimation equation (GEE) indicated that VR intervention was negatively correlated with postoperative VAS values (ß = -0.830, S.E = 0.199, 95%CI (-1.220,-0.439), Wald χ2 = 17.359, p<0.05), in the meanwhile, VR also lower the incidence of moderate pain (VAS > 4) at 8 h postoperatively (12.1% vs 31.0%, p = 0.013). However, the 24 h tramadol usage remained unchanged. Patients in the VR group had better sleep quality (6.33 ± 2.3 vs. 4.12 ± 2.5, p < 0.001) and lower incidence of nausea (43.1% vs. 63.2%, p < 0.05), dizziness (0% vs. 14.0%, p < 0.05), and headache (12.1% vs. 29.8%, p < 0.05). VR could reduce the median HADS scores (9.81 ± 6.1 vs 3.14 ± 3.9, p < 0.001) and blood pressure preoperatively. CONCLUSIONS: VR intervention can reduce acute postoperative pain with better postoperative recovery and lower preoperative anxiety level in adult female patients undergoing laparoscopic gynecology surgery.

Virtual parental presence with coaching for reducing preoperative anxiety in children: a feasibility and pilot randomized controlled trial.

BACKGROUND: Preoperative anxiety in children causes negative postoperative outcomes. Parental presence at induction is a non-pharmacological strategy for relieving anxiety; nevertheless, it is not always possible or effective, namely when parents are overly anxious. Parental presence via video has been demonstrated to be useful in other contexts (divorce, criminal court). This study reports the feasibility of a randomized controlled trial to investigate the effect of video parental presence and parental coaching at induction on preoperative anxiety. METHODS: The study was a randomized, 2 × 2 factorial design trial examining parental presence (virtual vs. physical) and coaching (provided vs. not provided). Feasibility was assessed by enrollment rate, attrition rate, compliance, and staff satisfaction with virtual method with the NASA-Task Load Index (NASA-TLX) and System Usability Scale (SUS). For the children's anxiety and postoperative outcomes, the modified Yale Preoperative Anxiety Scale (mYPAS) and Post-Hospitalization Behavioral Questionnaire (PHBQ) were used. Parental anxiety was evaluated with the State-Trait Anxiety Inventory (STAI) questionnaire. RESULTS: A total of 41 parent/patient dyads were recruited. The enrollment rate was 32.2%, the attrition rate 25.5%. Compliance was 87.8% for parents and 85% for staff. The SUS was 67.5/100 and 63.5/100 and NASA-TLX was 29.2 (21.5-36.8) and 27.6 (8.2-3.7) for the anesthesiologists and induction nurses, respectively. No statistically significant difference was found in mYPAS, PHBQ and STAI. CONCLUSION: A randomized controlled trial to explore virtual parental presence effect on preoperative anxiety is feasible. Further studies are needed to investigate its role and the role of parent coaching in reducing preoperative anxiety.

PAS-7 is Superior to APAIS for Assessing Preoperative Anxiety in the Chinese Population.

PURPOSE: The purpose of this study was to analyze the reliability and validity of the Perioperative Anxiety Scale-7 (PAS-7), which was created by Chinese medical professionals, by using the State-Trait Anxiety Scale (STAI-S) as the standard for the diagnosis of preoperative anxiety, and to compare whether there is a difference between the PAS-7 and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the diagnosis of preoperative anxiety in the Chinese population. DESIGN: This study was an observational study. METHODS: The PAS-7, APAIS, and STAI-S were all completed the day before surgery. The internal consistency test was used to evaluate the scale's reliability, and exploratory factor analysis and confirmatory factor analysis were used to assess the scale's construct validity. Pearson correlation was used to analyze the correlation between PAS-7 and STAI-S, and APAIS. The area under the receiver operating characteristic (ROC) curve was used to compare the diagnostic value of PAS-7 and APAIS. FINDINGS: The PAS-7 Cronbach's α coefficient was 0.804. The indicators of the overall fitting coefficient were within the acceptable range. PAS-7 scores correlated well with STAI-S and APAIS scores (P < .01). The area under the ROC curve of PAS-7 was 0.808 (0.752-0.856), and the area under the ROC curve of APAIS was 0.674 (0.611-0.733). The difference between areas was 0.133 (0.0612-0.206), P < .001, and the diagnostic value of PAS-7 was higher than that of APAIS. CONCLUSIONS: The PAS-7 scale has high reliability and validity and can be used to assess preoperative anxiety in patients undergoing elective surgery. PAS-7 is superior to APAIS for assessing preoperative anxiety in the Chinese population.

Incidence and risk factors of post-operative delirium in glioma patients: A prospective cohort study in general wards.

AIMS: Glioma patients are at high risk for postoperative delirium (POD), yet studies focusing on this population in general neurosurgical ward settings are limited. This paper investigates the incidence of POD and related risk factors in glioma patients hospitalized in general wards. DESIGN: Prospective observational study. METHODS: This prospective study included 133 adult glioma patients hospitalized in the general neurosurgery ward. In addition to collecting routine perioperative general clinical data, patients' psychological status was assessed preoperatively using the Hospital Anxiety and Depression Scale (HADS). POD was assessed within 3 days postoperatively using the Confusion of Consciousness Assessment method, twice daily. The incidence of POD was calculated, and risk factors were identified using logistic regression analysis. RESULTS: The incidence of POD in glioma patients admitted to the general ward was 31.6% (40/133). Multivariate regression revealed advanced age (age > 50 years), frontal lobe tumour, presence of preoperative anxiety or depression, retention of a luminal drain, postoperative pain, indwelling catheter these six factors were independent risk factors for the development of delirium in patients after surgery. CONCLUSION: In general ward settings, supratentorial glioma patients exhibit a high risk of POD. Critical risk factors include preoperative psychological conditions, as well as postoperative pain, drainage and catheterization. Rigorous preoperative evaluations, effective pain management strategies and the integration of humanistic care principles are essential in mitigating the risk of POD for glioma patients. RELEVANCE TO CLINICAL PRACTICE: In general ward settings, this study reveals the high occurrence of POD in glioma patients and identifies preoperative psychological states, age, tumour location and several postoperative factors as significant risk factors for POD, which provides a framework for targeted interventions. By integrating these insights into clinical practice, healthcare teams can better identify glioma patients at risk for POD and implement preventive measures, thereby enhancing recovery and overall care quality for glioma patients in general neurosurgical wards. REPORTING METHOD: This study adheres to the STROBE guidelines, ensuring a transparent and comprehensive reporting of the observational research methodology and results. PATIENT OR PUBLIC CONTRIBUTION: Patients involvement was limited to the provision of data through their participation in the study's assessments and the collection of clinical information. The study did not involve a direct patient or public contribution in the design, conduct, analysis, or interpretation of the data, nor in the preparation of the manuscript.

Study on the application of segmented nursing pathway in daytime anorectal surgery patients.

BACKGROUND: Standardised management of day surgery for haemorrhoids and achieving standardised nursing in the painless ward of colorectal surgery are important. OBJECTIVE: To explore the role of segmented nursing pathways in patients undergoing day surgery for anorectal procedures and to provide theoretical and practical guidance for day surgery nursing. METHODS: A total of 146 patients undergoing anorectal surgery in our day surgery ward between April 2023 and July 2023 were selected as the study participants, with 74 patients in the control group receiving routine nursing and 72 patients in the experimental group receiving segmented nursing. The preoperative preparedness, preoperative anxiety, complication rate, discharge preparedness and nursing satisfaction were compared between the two groups. RESULTS: The experimental group had higher rates of admission before 8:30 am (77.78% vs 45.95%), awareness of the day surgery process (63.89% vs 24.32%), completion rate of preoperative preparation (81.94% vs 59.46%), satisfaction with preoperative preparation (94.44% vs 74.32%), discharge preparedness (112.42 ± 3.28 vs 95.82 ± 3.41) and nursing satisfaction (97.22% vs 70.27%) compared with the control group (P< 0.05). After the intervention, the self-rating anxiety scale score (43.14 ± 12.44 vs 52.51 ± 13.21) and the self-rating depression scale score (45.03 ± 11.37 vs 55.37 ± 10.14) were lower in the experimental group than in the control group (P< 0.05). CONCLUSION: Segmented nursing pathways can improve the preoperative preparedness of patients undergoing day surgery for anorectal procedures, alleviate patient anxiety, enhance discharge preparedness, improve the quality of nursing care and increase nursing satisfaction.

Assessing the Premedication Properties of Sublingual Melatonin in Young Women Undergoing Cesarean Section With Spinal Anesthesia: A Double-Blind Randomized Study.

INTRODUCTION: Preoperative anxiety can negatively impact patient outcomes by influencing the intraoperative requirements for anesthetics and analgesics, increasing postoperative pain intensity, and augmenting the need for analgesia. Moreover, it may contribute to higher rates of postoperative morbidity and mortality following certain types of surgery. This study investigates the anxiolytic and sedative properties of sublingual melatonin as a premedication agent in young females undergoing cesarean section under spinal anesthesia. METHODS: A double-blind, randomized, placebo-controlled trial was conducted in Nasiriyah, Iraq. Eighty females were included, 40 in each group, based on specific inclusion and exclusion criteria. Premedication was administered in the morning, 60 minutes before the procedure. In the melatonin group (M), patients received 10 mg of sublingual melatonin, while the placebo group (P) received placebo premedication. Anxiety and sedation levels were evaluated three times: before taking premedication, five minutes before the insertion of the spinal needle, and one hour postoperatively, using the visual analog scale and Richmond Sedation Scale. RESULTS: The results show a highly significant P-value regarding anxiety levels between the M Group and P Group (p-value < 0.001). There was a significant difference in the median sedation scores between the studied groups at pre-spinal insertion and postoperatively (p-value < 0.001). The mean heart rate in the M Group was significantly lower than in the P Group (p-value = 0.0019). Significant differences were noted in systolic and diastolic blood pressures between the two groups, measured five minutes before and after spinal needle insertion (p-value < 0.001). CONCLUSION: These findings contribute to understanding the impact of sublingual melatonin as an anxiolytic and sedative premedication agent on patients undergoing elective cesarean sections under spinal anesthesia. Further research is warranted to fully elucidate the benefits and implications of melatonin administration in such procedures.

Exploring Preoperative Experiences and Informational Needs Among Chinese School-Age Children Undergoing Elective Surgery: A Qualitative Study.

AIM: To understand preoperative experiences and information needs of Chinese school-aged children undergoing elective surgery to design standardized preoperative education programs to alleviate preoperative anxiety. METHODS: Semi-structured interviews combined with drawing, writing, and telling techniques were conducted in 12 children. The paintings were interpreted alongside children's verbal expressions. All data were analyzed using thematic analysis. RESULTS: Three themes emerged: Origins of Surgical Knowledge: Proximity-based knowledge, media exposure, past personal medical experiences, ward-mate interactions, healthcare staff education; Pre-Surgery Experiences: Anticipation of pain, post-op sensations and impact on life, fantasizing about the operation, being aware of risks, demonstrating psychological resilience, being curious about anesthesia experience, enjoying a break; Preoperative Informational Needs: 55 identified. CONCLUSIONS: Lack of standardized preoperative education creates a gap between children's knowledge and actual surgical experiences. Developing preoperative education tailored to individualized informational needs and developmental level helps fill their gaps, alleviate preoperative anxiety and improve health outcomes.

Phantom Vision: A Benign, Intraoperative Visual Experience in Cataract Surgery.

The intraoperative experience of cataract surgery can be a source of fear and anxiety for many patients. We present a testimonial and illustrations of the intraoperative "phantom vision" experience of a 72-year-old commercial artist during her uncomplicated microincision cataract surgery. She describes a pleasant, colorful, dynamic intraoperative visual experience. First-hand reports from patients can be used in preoperative counseling to reduce anxiety associated with common "visual" phenomena experienced during cataract surgery.

Comparing Conventional Physician-Led Education with VR Education for Pacemaker Implantation: A Randomized Study.

INTRODUCTION: Education of patients prior to an invasive procedure is pivotal for good cooperation and knowledge retention. Virtual reality (VR) is a fast-developing technology that helps educate both medical professionals and patients. OBJECTIVE: To prove non-inferiority of VR education compared to conventional education in patients prior to the implantation of a permanent pacemaker (PPM). METHODS: 150 participants scheduled for an elective implantation of a PPM were enrolled in this prospective study and randomized into two groups: the VR group (n = 75) watched a 360° video about the procedure using the VR headset Oculus Meta Quest 2, while the conventional group (n = 75) was educated by a physician. Both groups filled out a questionnaire to assess the quality of education pre- and in-hospital, their knowledge of the procedure, and their subjective satisfaction. RESULTS: There was no significant difference in the quality of education. There was a non-significant trend towards higher educational scores in the VR group. The subgroup with worse scores was older than the groups with higher scores (82 vs. 76 years, p = 0.025). Anxiety was reduced in 92% of participants. CONCLUSION: VR proved to be non-inferior to conventional education. It helped to reduce anxiety and showed no adverse effects.

An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial.

BACKGROUND: Preoperative state anxiety (PSA) is distress and anxiety directly associated with perioperative events. PSA is associated with negative postoperative outcomes such as longer hospital length of stay, increased pain and opioid use, and higher rates of rehospitalization. Psychological prehabilitation, such as education, exposure to hospital environments, and relaxation strategies, has been shown to mitigate PSA; however, there are limited skilled personnel to deliver such interventions in clinical practice. Immersive virtual reality (VR) has the potential for greater accessibility and enhanced integration into an immersive and interactive experience. VR is rarely used in the preoperative setting, but similar forms of stress inoculation training involving exposure to stressful events have improved psychological preparation in contexts such as military deployment. OBJECTIVE: This study seeks to develop and investigate a targeted PSA intervention in patients undergoing oncological surgery using a single preoperative VR exposure. The primary objectives are to (1) develop a novel VR program for patients undergoing oncological surgery with general anesthesia; (2) assess the feasibility, including acceptability, of a single exposure to this intervention; (3) assess the feasibility, including acceptability, of outcome measures of PSA; and (4) use these results to refine the VR content and outcome measures for a larger trial. A secondary objective is to preliminarily assess the clinical utility of the intervention for PSA. METHODS: This study comprises 3 phases. Phase 1 (completed) involved the development of a VR prototype targeting PSA, using multidisciplinary iterative input. Phase 2 (data collection completed) involves examining the feasibility aspects of the VR intervention. This randomized feasibility trial involves assessing the novel VR preoperative intervention compared to a VR control (ie, nature trek) condition and a treatment-as-usual group among patients undergoing breast cancer surgery. Phase 3 will involve refining the prototype based on feasibility findings and input from people with lived experience for a future clinical trial, using focus groups with participants from phase 2. RESULTS: This study was funded in March 2019. Phase 1 was completed in April 2020. Phase 2 data collection was completed in January 2024 and data analysis is ongoing. Focus groups were completed in February 2024. Both the feasibility study and focus groups will contribute to further refinement of the initial VR prototype (phase 3), with the final simulation to be completed by mid-2024. CONCLUSIONS: The findings from this work will contribute to the limited body of research examining feasible and broadly accessible interventions for PSA. Knowledge gained from this research will contribute to the final development of a novel VR intervention to be tested in a large population of patients with cancer before surgery in a randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04544618; https://www.clinicaltrials.gov/study/NCT04544618. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55692.

Preoperative Anxiolytic and Sedative Effects of Intranasal Remimazolam and Dexmedetomidine: A Randomized Controlled Clinical Study in Children Undergoing General Surgeries.

Purpose: Remimazolam, an ultra-short-acting and fast-metabolized sedative, has only been sporadically investigated in children. This study was performed to determine the beneficial effects of intranasal remimazolam or dexmedetomidine on preoperative anxiety in children undergoing general surgeries. Patients and Methods: Ninety children were randomly and equally assigned to Group R (intranasal remimazolam 1.5mg kg-1), Group D (intranasal dexmedetomidine 2 mcg kg-1), and Group C (intranasal distilled water). The primary outcomes were the preoperative anxiety scores using the modified Yale preoperative anxiety scale (m-Ypas). The secondary outcomes included the cooperation behaviour of intranasal drug application, preoperative sedation levels, parental separation anxiety scores (PSAS), and mask acceptance scores (MAS). Results: Group R showed a significant low anxiety at 10 min after intranasal premedication (vs group C, P=0.010; vs group D, P = 0.002) and at anaesthesia induction (vs group C, P = 0.004). Group D showed a significantly low anxiety score only prior to anaesthesia induction (vs group C, P = 0.005). Most children in group R achieved mild sedation at 10 min (vs group C, P < 0.001; vs group D, P < 0.001), with a few progressing to deep sedation afterwards, while group D tended toward deep sedation. Compared to Group C, patients in Group R performed significantly better on the MAS (P = 0.014) and PSAS (P = 0.008). However, remimazolam did cause poor cooperation behavior to the intranasal application due to its mucosal irritation (vs group C, P = 0.001; vs group D, P = 0.010). Conclusion: Both intranasal remimazolam and dexmedetomidine can effectively alleviate preoperative anxiety in children. While intranasal remimazolam has a rapid onset, it produces only mild sedation and causes substantial nasal irritation. Trial Registration: NCT04720963, January 22, 2021, ClinicalTrials.Gov.

Cross-sectional and Correlational Examination of Patients' Preoperative Anxiety, Information Need, and Health Literacy in a Presurgical Consultation.

PURPOSE: This study elucidates the preoperative anxiety (PA), information need (IN), and health literacy (HL) levels of an elective preoperative sample in Switzerland and examines the possible associations between PA and the patients' characteristics. By knowing these patient dimensions, which can influence perioperative outcomes, one can tailor individualized nursing interventions to improve patients' surgical experience. DESIGN: This was a cross-sectional and correlational study. METHODS: The sample consisted of 88 patients who underwent a preoperative consultation at a Swiss tertiary hosptial. Patients' PA and IN were assessed using the Anxiety Preoperative and Information Scale, and their HL was measured using the Functional, Communicative, and Critical Health Literacy Scale. Data on other patient characteristics were collected from the patients, physicians, and electronic patient records. Association tests, as well as univariate regressions, were performed on PA, IN, HL, and patient characteristics. FINDINGS: Among participants, 40.91%, 78.41%, and 59% reported having PA, IN, and low HL, respectively. Finally, PA was associated with IN, HL, solitary living, and the American Society of Anesthesiology score. CONCLUSIONS: A high proportion of patients scheduled for presurgical consultation were found to be anxious. They presented high IN and low HL. An examination of patients' PA-associated characteristics can help improve their surgical experience. More studies should examine PA-associated characteristics.

Measures of preoperative anxiety: Part two.

The current literature indicates that routine evaluation of preoperative anxiety, its determinants, and patient-specific concerns is universally advocated. This aligns with the increasingly acknowledged importance of prehabilitation - a comprehensive process preparing patients for surgery. A crucial component of prehabilitation is assessing patients' mental health. Recommendations for psychological evaluations in prehabilitation encompass, inter alia, determining the severity of anxiety. This work builds on a 2019 article, which presented scales for preoperative anxiety assessment: the State Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and the Visual Analogue Scale (VAS). This article extends the possibilities of preoperative anxiety assessment by introducing four additional methods: the Surgical Fear Questionnaire (SFQ), the Anxiety Specific to Surgery Questionnaire (ASSQ), the Surgical Anxiety Questionnaire (SAQ), and Anesthesia- and Surgery-dependent Preoperative Anxiety (ASPA). The authors provide comprehensive details on these instruments, including scoring, interpretation, availability, and usefulness both in scientific research and clinical practice. The authors also provide the data on the availability of Polish versions of the presented methods and preliminary data on the reliability of SFQ in patients awaiting cardiac surgery. This review seems relevant for professionals in multiple disciplines, including anesthesiology, surgery, clinical psychology, nursing, primary care and notably prehabilitation. It emphasizes the necessity of individualizing anxiety assessment and acknowledging patient subjectivity, which the presented methods facilitate through a thorough evaluation of specific patient concerns. The literature review also identifies concerns and future research avenues in this area. The importance of qualitative studies and those evaluating prehabilitation intervention is emphasized.

The effect on perioperative anxiety and emergence delirium of the child or parent's preference for parental accompaniment during anesthesia induction in children undergoing adenotonsillectomy surgery.

BACKGROUND: Pediatric emergence delirium (ED) occurs in the early postoperative period and is defined as a complex psychiatric disorder. Non-pharmacological methods of treatment, such as perioperative parental presence, have been the focus of many studies, but the impact on preventing ED of which parent accompanies the child during anesthesia induction has not been identified as yet. Therefore, the aim of this study was to determine whether the selection made by children undergoing adenotonsillectomy of which parent will accompany them during anesthesia induction has the effect of reducing postoperative delirium scores and incidence compared to selections made by the parents. METHODS: The study included 80 children of both genders, aged 5-12 years, who underwent day-case surgery in the otorhinolaryngology clinic. The patients were separated randomly into two groups of 40. In Group 1, the children were asked to choose which of their parents would accompany them during general anesthesia induction, and in Group 2, the parents were asked to decide who would be the accompanying parent. Evaluation of postoperative delirium was made using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The anxiety level of the children was evaluated with the modified Yale Preoperative Anxiety Scale (mYPAS) both in the preoperative waiting area and during the anesthesia induction. The State-Trait Anxiety Inventory (STAI) was used to evaluate the anxiety level of the parents. RESULTS: The mean PAED scores were similar in both groups (mean difference [95% CI]: -0.1 [-2.8 to 0.7]). The incidence of emergence delirium was also similar in both groups (risk ratio 0.9 [0.4 to 1.8]). The mean mYPAS scores during the induction of anesthesia of Group 1 was lower than that of Group 2 (mean difference [95% CI]: -8.4 [-15.2 to -1.6]). The mean mYPAS scores evaluated in the preoperative waiting area were found to be similar in the two groups (mean difference [95% CI]: -1.9 [-7.5 to 3.5]). The mean STAI anxiety scores of the parents were similar in both groups, with higher scores obtained by mothers compared to fathers, at all measurement times. CONCLUSION: The incidence or severity of ED did not decrease significantly even though lower anxiety scores were obtained during anesthesia induction in children who were allowed to make the decision of accompanying parent. Based on these findings, it can be concluded that postoperative delirium is a more complicated process that can be affected by many other variables rather than just the parent-child general interaction.

Effectiveness of WeChat-assisted preoperative education to reduce perioperative anxiety in breast cancer patients: a prospective randomized controlled study protocol.

BACKGROUND: Breast cancer is the most prevalent cancer among women globally, and surgical procedures continue to be the primary treatment. However, over 50% of patients experience preoperative anxiety due to the unknown and fear associated with surgery. Although drug therapy is commonly used to address this anxiety, its side effects have led to a heated debate regarding its effectiveness. Consequently, non-pharmacological therapies, such as preoperative education, have emerged as an alternative approach to alleviate anxiety. WeChat, a widely popular social media platform, offers a public platform that can potentially be utilized for effective preoperative education. This study aims to evaluate the use of WeChat public platform as a tool for preoperative education in patients undergoing breast surgery. METHODS: This is a prospective, randomized, and controlled trial will involve 392 adult women scheduled for breast cancer resection. Participants will be randomly assigned to either the WeChat education group or the regular group. In addition to regular preoperative visits, the WeChat education group will also watch science videos through the WeChat public platform. The regular group will only receive education from ward nurses during preoperative visits. The primary outcome measure will be the incidence of preoperative anxiety, defined by scores of the State Anxiety Inventory (SAI) exceeding 40 points. Secondary outcome measures include the incidence of severe anxiety (SAI > 44) on the day before surgery, incidence of anxiety 72 h after surgery, incidence of severe anxiety 72 h after surgery, NRS scores for pain at rest and during activity 24, 48, and 72 h after surgery, incidence of nausea and vomiting within 24 h after surgery, subjective sleep score at 1 week postoperatively, quality of life QoR-15 scores at 1 and 3 months postoperatively, incidence of chronic pain at 3 months postoperatively, bowel function recovery, length of hospital stay, and hospitalization expenses. DISCUSSION: This is the first clinical trial to investigate the use of WeChat public platform for delivering preoperative education on perioperative anxiety in breast cancer patients. By utilizing the renowned WeChat public platform, our study aims to improve patient outcomes by providing video education that explains the disease, surgery, and anesthesia in a more accessible manner, thereby reducing the incidence of perioperative anxiety. If our hypothesis is confirmed, this non-pharmacological approach can be universally acknowledged as a cost-effective and practical method in clinical care. Its application can also be extended to other medical fields beyond breast cancer. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05291494. Registered on 29 December 2021.

A bibliometric analysis of research on pediatric preoperative anxiety (2007-2022).

Objective: This study aimed to analyze the current state of research on preoperative anxiety in children through CiteSpace, VOSviewer, and the identification of hot spots and frontiers. Method: Relevant data were retrieved from the Web of Science Core Collection using the search terms children and preoperative anxiety. Data were analyzed using VOSviewer (version 1.6.18), CiteSpace (5.7. R5) software, and Scimago Graphica. Results: A total of 622 articles were published between 2007 and 2022, with an increasing trend over time. Kain, Zeev N. (13; 2.09%) and Dalhousie University (15; 2.41%) were the most influential authors and most prolific institutions, respectively. The United States (121; 19.45%) was the country with the most publications. Pediatric anesthesia (55; 8.84%) had the most publications. High-frequency keywords were categorized into three themes, including nonpharmacologic interventions for preoperative anxiety in children, preoperative medications, and risk factors for anxiety; of these, "predictor" (38; 2016) and "sedative premedication" (20; 2016) were the most studied keywords over the past 6 years. "Distraction" (67; 2019) and "dexmedetomidine" (65; 2019) have been the main areas of interest in recent years. Conclusion: Research on preoperative anxiety in children has been the focus of increasing attention over the past fifteen years, with the majority of publications from high-income countries. This review provides a useful perspective for understanding research trends, hot topics, and research gaps in this expanding field.

Patient Anxiety in Endoscopy: A Comparative Analysis of Single vs. Dual Procedure Effects.

AIM: This study aimed to investigate the difference in anxiety levels between patients undergoing gastroscopy only and those subjected to both gastroscopy and colonoscopy. Despite known preoperative anxiety impacts, no prior research has compared these specific patient groups. MATERIALS AND METHODS: A total of 150 patients were divided equally into two groups: Group I, undergoing gastroscopy only, and Group II, undergoing gastroscopy and colonoscopy. Inclusion criteria were patients in the age range 18-70 years and having an ASA (American Society of Anesthesiologists) physical status classification of I-III. Exclusion criteria were patients outside the age range, and patients with hearing disorders, psychiatric disorders, dementia, or recent anxiolytic drug use. Anxiety was analysed using the Beck Anxiety Inventory Scale before procedures, without any premedication. RESULTS: Patients in Group II had significantly higher anxiety levels, with particular increases noted in symptoms such as leg weakness and tremors, inability to relax, and fears of adverse events and death. These results highlighted a considerable elevation in anxiety among patients anticipating or undergoing combined endoscopic procedures. DISCUSSION: The findings revealed that undergoing combined gastroscopy and colonoscopy procedures significantly elevated patient anxiety levels compared to gastroscopy alone. This suggests a critical need for healthcare providers to implement more strong preoperative counselling and anxiety reduction strategies for patients facing multiple procedures. Addressing this increased anxiety could lead to better patient experiences, reduced procedural complications, and improved satisfaction and outcomes.

Anxiolytic and Sedative Properties of Melatonin Premedication in Pediatrics Undergoing Elective Cardiac Catheterization: A Randomized Placebo Study.

BACKGROUND: Preoperative anxiety in children has been linked to various postoperative consequences, such as postoperative regressive behavioral issues, extended distress during the recovery period, eating disorders, and bedwetting. The current study aimed to investigate the efficacy of low-dose oral melatonin in alleviating preoperative anxiety among children in the Iraqi population. STUDY DESIGN: A randomized, double-blinded comparative study was undertaken, involving children aged four to 14 years scheduled for elective cardiac catheterization under general anesthesia. The study comprised a total of 80 children. The involved individuals were randomly assigned to two groups, each with 40 subjects. Group A received 0.5 mg/kg melatonin as premedication, while Group B received a placebo. RESULTS: The two groups demonstrated similarity in mean age, weight, cardiac disease, and gender distribution. Statistically significant reductions in anxiety scores were observed in the melatonin group compared to the placebo group. Particularly, children administered 0.5 mg/kg melatonin exhibited the most substantial anxiolysis and venipuncture compliance (P < 0.05). Additionally, children who were premedicated with melatonin experienced decreased cognition, maximum sedation, successful parental separation, and psychomotor impairment (P < 0.05). CONCLUSIONS: Melatonin demonstrated an effective sedation level without significant side effects, making it a preferred choice due to its efficacy, safety, current availability, and cost-effectiveness compared to other anesthetic agents used in premedication procedures.