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.

Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study

Abstract Backgraund: This prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy. Methods: Forty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1st, 4th, 12th, and 24th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values obtained from the final model. Results: There was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups. Conclusion: In this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.

Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study.

BACKGRAUND: This prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy. METHODS: Forty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1st, 4th, 12th, and 24th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values ​​obtained from the final model. RESULTS: There was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups. CONCLUSION: In this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.

Impacto de un programa de educación estructurado sobre el nivel de ansiedad preoperatoria de pacientes pediátricos y de sus padres / Impact of a structured education program on preoperative anxiety level in pediatric patients and their parents

Introducción: los pacientes pediátricos y sus padres sienten ansiedad antes de una cirugía, síntoma que afecta la inducción anestésica, el dolor y el comportamiento postoperatorio. El objetivo fue evaluar el efecto de la educación preoperatoria estructurada en el nivel de ansiedad de niños sometidos a cirugía electiva y de sus padres. Métodos: estudio prospectivo, aleatorio, doble ciego, en niños de 2-12 años, ASA I-II. Los participantes fueron aleatorizados en grupo control (información habitual) y grupo experimental (información estructurada). Se registraron variables demográficas, nivel de ansiedad en unidad preoperatoria y en pabellón en niños y padres; se evaluó el comportamiento de los niños durante la inducción anestésica. Análisis estadístico: t-test, x2; valores expresados en media y desviación estándar; significancia p ≤ 0,05. Resultados: se reclutaron 34 pacientes, 18 en grupo control y 16 en grupo experimental. Los valores ansiedad en niños pre-pabellón fueron 37,7 ± 21,4 en grupo control y 31,9 ± 11,5 en grupo experimental (p= 0,35); durante pre-inducción fue 43,2 ± 25,3 y 36 ± 15,5 respectivamente (p= 0,33). Los niveles de ansiedad en padres pre-pabellón fueron 42,5 ± 15,5 para grupo control y 37,6 ± 6,9 en grupo experimental (p= 0,25), y al retirarse del pabellón fueron de 45,1 ± 16,6 y 43,9 ± 9,8 respectivamente (p= 0,82). No hubo diferencias en el comportamiento durante la inducción anestésica entre ambos grupos (p= 0,24). Conclusiones: no fue posible demostrar efectos de información estructurada en niveles de ansiedad en niños que van a ser operados y en sus padres.

Introduction: Pediatric patients and their parents experience anxiety before surgery, a symptom that affects anesthetic induction, pain and postoperative behavior. The objective was to evaluate the effect of structured preoperative education on the anxiety level in children undergoing elective surgery and their parents. Methods: A prospective, randomized, double-blind study in children aged 2-12 years, ASA I-II. Patients were randomized into a control group (usual preoperative information) and an experimental group (structured information). Demographic variables, anxiety level in the preoperative unit and in operating room in children and parents were recorded; the behavior of children during anesthetic induction was evaluated. Statistical analysis: t-test, x2; values expressed as mean and standard deviation; significance p ≤ 0.05. Results: 34 patients were recruited, 18 in the control group and 16 in the experimental group. The anxiety levels in children in preoperative unit were 37.7 ± 21 and 31.9 ± 11.5.4 in control and experimental group, respectively (p = 0.35), and in operating room were 43.2 ± 25.3 and 36 ± 15.5 respectively (p = 0.33). Parental anxiety levels in preoperative unit were 42.5 ± 15.5 in control group and 37.6 ± 6.9 in experimental group (p = 0.25), and when they leaving operating room were 45.1 ± 16.6 and 43.9 ± 9.8 respectively (p = 0.82). There were no differences in the behavior during anesthetic induction between both groups (p = 0.24). Conclusions: It was not possible to demonstrate effects of structured information on anxiety levels in children undergoing surgery and in their parents.

[The relation between preoperative anxiety and awareness during anesthesia: an observational study]. / Relação entre ansiedade pré­operatória e consciência durante a anestesia: estudo observacional.

BACKGROUND: Anxiety is a state of worry caused by the anticipation of external or internal danger. Awareness During Anesthesia (ADA) is an unexpected memory recall during anesthesia. In this study, we aimed to determine the factors that affect preoperative anxiety and observe the incidence of ADA, as well as to determine the anxiety levels of these patients with a history of ADA. METHODS: This study was planned to be prospective, observational, and cross-sectional. Patients in whom septoplasty was planned, who was admitted to the anesthesiology outpatients between March 2018 and September 2018, were ASA I-II, and aged 18-70 years were included in the study. The demographic characteristics of patients were recorded. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety during a preoperative evaluation. The modified Brice awareness score was used simultaneously to determine previous ADA. RESULTS: The anxiety scores of patients who were conscious during anesthesia were higher than other patients. The mean STAI score was 40.85±14.8 in the 799 patients who met the inclusion criteria of this study. When the anxiety scores were compared, the scores were higher in females than in males (p < 0.05). The mean STAI score was found as 40.3±13.8 in patients who dreamed during anesthesia. CONCLUSION: It is important to determine the anxiety levels of patients in the preoperative period to prevent the associated complications. Preoperative anxiety, besides preventing ADA, should be dealt with in a multidisciplinary manner. ADA should be carefully questioned while evaluating previous anesthesia experiences.

The relation between preoperative anxiety and awareness during anesthesia: an observational study / Relação entre ansiedade pré-operatória e consciência durante a anestesia: estudo observacional

Abstract Background: Anxiety is a state of worry caused by the anticipation of external or internal danger. Awareness During Anesthesia (ADA) is an unexpected memory recall during anesthesia. In this study, we aimed to determine the factors that affect preoperative anxiety and observe the incidence of ADA, as well as to determine the anxiety levels of these patients with a history of ADA. Methods: This study was planned to be prospective, observational, and cross-sectional. Patients in whom septoplasty was planned, who was admitted to the anesthesiology outpatients between March 2018 and September 2018, were ASA I-II, and aged 18-70 years were included in the study. The demographic characteristics of patients were recorded. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety during a preoperative evaluation. The modified Brice awareness score was used simultaneously to determine previous ADA. Results: The anxiety scores of patients who were conscious during anesthesia were higher than other patients. The mean STAI score was 40.85 ± 14.8 in the 799 patients who met the inclusion criteria of this study. When the anxiety scores were compared, the scores were higher in females than in males (p < 0.05). The mean STAI score was found as 40.3 ± 13.8 in patients who dreamed during anesthesia. Conclusion: It is important to determine the anxiety levels of patients in the preoperative period to prevent the associated complications. Preoperative anxiety, besides preventing ADA, should be dealt with in a multidisciplinary manner. ADA should be carefully questioned while evaluating previous anesthesia experiences.

Resumo Justificativa: A ansiedade é um estado de preocupação causado pela expectativa de perigo externo ou interno. Consciência durante a anestesia (CDA) é a evocação imprevista da memória de eventos intranestésicos. O objetivo deste estudo foi determinar os fatores que afetam a ansiedade pré-operatória, a incidência de CDA e os níveis de ansiedade nos pacientes com antecedente de CDA. Método: O estudo foi planificado como prospectivo, observacional e transversal. Foram incluídos no estudo pacientes programados para septoplastia eletiva, admitidos ao ambulatório de anestesiologia entre Março de 2018 e Setembro de 2018, com classe funcional ASA I-II e faixa etária entre 18 e 70 anos. As características demográficas dos pacientes foram registradas. O Inventário de Ansiedade Traço-Estado (IDATE) foi utilizado para determinar a ansiedade durante a avaliação pré-operatória. Simultaneamente, o escore de consciência de Brice modificado foi usado para determinar CDA anterior. Resultados: Os escores de ansiedade dos pacientes que apresentaram CDA foram mais elevados do que de outros pacientes. A pontuação média do IDATE foi 40,85±14,8 nos 799 pacientes que obedeceram aos critérios de inclusão do estudo. Quando os escores de ansiedade foram comparados, foram maiores no sexo feminino do que no masculino (p < 0,05). O escore médio do IDATE encontrado foi 40,3±13,8 nos pacientes que relataram sonhos durante a anestesia. Conclusão: É importante determinar no pré-operatório os níveis de ansiedade dos pacientes para evitar as complicações associadas. Ansiedade pré-operatória e a prevenção de CDA devem ser tratadas com abordagem multiprofissional. A CDA deve ser cuidadosamente investigada, avaliando-se as experiências vividas pelo paciente em anestesias pregressas.

Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean.

OBJECTIVES: Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients. DESIGN AND METHODS: A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients' preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative 'expected' pain score was recorded. Postoperatively, 'observed' pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression. RESULTS: A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores. CONCLUSION: The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period.

¿Qué información preoperatoria desean los padres de niños que serán operados? / What preoperative information do the parents of children undergoing surgery want?

Introducción: Los padres sienten miedo y ansiedad antes de la cirugía de un hijo(a), lo que dificulta su preparación para la cirugía. Estos sentimientos podrían ser aliviados con adecuada información preoperatoria. Objetivo: Determinar las necesidades de información preoperatoria de los padres de niños que serán operados electivamente. Pacientes y método: Se encuestó a padres de pacientes pediátricos sometidos a cirugía electiva. Se registraron variables demográficas de los padres. Se evaluó la información preoperatoria que recibieron o desearían haber recibido en cuanto a contenidos, medios, oportunidad, lugar e informante. Se utilizó estadística descriptiva. Resultados: Ciento trece padres fueron encuestados, y más del 80% de ellos desea recibir información preoperatoria sobre la anestesia, la cirugía, el ayuno previo, los medicamentos y las complicaciones anestésicas, la monitorización, el manejo de la vía venosa, el manejo del dolor, la alimentación postoperatoria, el control de ansiedad, la sala de hospitalización y la de recuperación, y la entretención en recuperación. La mayoría desea ser informado verbalmente, 1 a 2 semanas antes y no el día de la cirugía; que el informante sea el cirujano en su consulta. Además, desean información a través de folletos, vídeos o talleres de simulación. Conclusiones: Los padres necesitan información preoperatoria completa de la anestesia, la cirugía y los cuidados postoperatorios, entregada verbalmente y en forma anticipada.

Introduction: Parents feel fear and anxiety before surgery is performed on their child, and those feelings could obstruct their preparation for the surgery. Preoperative information could relieve those feelings. Objective: To determine the preoperative information needs of parents of children undergoing elective surgery. Patients and method: A study was conducted on the parents of children who underwent elective surgery. Demographic data of parents were recorded. Preoperative information received or would like to have received was assessed in terms of contents, methods, opportunity, place and informant. Descriptive statistics were used. Results: Thirteen hundred parents were surveyed. More than 80% of them want preoperative information about anaesthesia, surgery, preoperative fasting, drugs and anaesthetic complications, monitoring, intravenous line management, pain treatment, postoperative feeding, anxiety control, hospitalisation room, recovery room, and entertainment in recovery room. Most want to be informed verbally, one to two weeks in advance and not on the same day of surgery. The informant should be the surgeon and in his office. In addition, they want information through leaflets, videos and simulation workshops, or guided tours. Conclusions: Parents need complete preoperative information about anesthesia, surgery and postoperative care, received verbally and in advance.

[What preoperative information do the parents of children undergoing surgery want?]. / Qué información preoperatoria desean los padres de niños que serán operados?

INTRODUCTION: Parents feel fear and anxiety before surgery is performed on their child, and those feelings could obstruct their preparation for the surgery. Preoperative information could relieve those feelings. OBJECTIVE: To determine the preoperative information needs of parents of children undergoing elective surgery. PATIENTS AND METHOD: A study was conducted on the parents of children who underwent elective surgery. Demographic data of parents were recorded. Preoperative information received or would like to have received was assessed in terms of contents, methods, opportunity, place and informant. Descriptive statistics were used. RESULTS: Thirteen hundred parents were surveyed. More than 80% of them want preoperative information about anaesthesia, surgery, preoperative fasting, drugs and anaesthetic complications, monitoring, intravenous line management, pain treatment, postoperative feeding, anxiety control, hospitalisation room, recovery room, and entertainment in recovery room. Most want to be informed verbally, one to two weeks in advance and not on the same day of surgery. The informant should be the surgeon and in his office. In addition, they want information through leaflets, videos and simulation workshops, or guided tours. CONCLUSIONS: Parents need complete preoperative information about anesthesia, surgery and postoperative care, received verbally and in advance.