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1.
Paediatr Anaesth ; 29(1): 51-58, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30375133

RESUMO

INTRODUCTION: Randomized trials are important for generating high-quality evidence, but are perceived as difficult to perform in the pediatric population. Thus far there has been poor characterization of the barriers to conducting trials involving children, and the variation in these barriers between countries remains undescribed. The General Anesthesia compared to Spinal anesthesia (GAS) trial, conducted in seven countries between 2007 and 2013, provides an opportunity to explore these issues. METHODS: We undertook a descriptive analysis to evaluate the reasons for variation in enrollment between countries in the GAS trial, looking specifically at the number of potential subjects screened, and the subsequent application of four exclusion criteria that were applied in a hierarchical order. RESULTS: A total of 4023 patients were screened by 28 centers in seven countries. Australia and the USA screened the most subjects, accounting for 84% of all potential trial participants. The percentage of subjects eliminated from the screened pool by each exclusion criterion varied between countries. Exclusion due to a predefined condition (H1) eliminated only 5% of potential subjects in Italy and the UK, but 37% in Canada. Exclusions due to a contraindication or a physician's refusal most impacted enrollment in Australia and the USA. The patient being "too large for spinal anesthesia" was the most commonly cited by anesthetists who refused to enroll a patient (64% of anesthetist refusals). The majority of surgeon refusals came from the USA, where surgeons preferred the patient to receive a general anesthetic. The percentage of approached parents refusing to consent ranged from a low of 3% in Italy to a high of 70% in the USA and Netherlands. The most frequently cited reason for parent refusal in all countries was a preference for general anesthesia (median: 43%, range: 32%-67%). However, a sizeable proportion of parents in all countries had a contrasting preference for spinal anesthesia (median: 25%, range: 13%-31%), and 23% of U.S. parents expressed concern about randomization. CONCLUSION: The GAS trial highlights enrollment challenges that can occur when conducting multicenter, international, pediatric studies. Investigators planning future trials should be aware of potential differences in screening processes across countries, and that exclusions by anesthetists and surgeons may vary in reason, in frequency, and by country. Furthermore, investigators should be aware that the U.S. centers encountered particularly high surgeon and parental refusal rates and that U.S. parents were uniquely concerned about randomization. Planning trials that address these difficulties should increase the likelihood of successfully recruiting subjects in pediatric trials.


Assuntos
Anestesia Geral/psicologia , Raquianestesia/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/psicologia , Recusa de Participação/psicologia , Anestesia Geral/métodos , Raquianestesia/métodos , Austrália , Europa (Continente) , Humanos , Lactente , Recém-Nascido , Estudos Multicêntricos como Assunto/psicologia , Nova Zelândia , América do Norte , Consentimento dos Pais/psicologia , Pais/psicologia
2.
Paediatr Anaesth ; 29(1): 98-105, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30365231

RESUMO

BACKGROUND AND AIMS: An immersive virtual reality tour of the operating theater could reduce preoperative anxiety. This study was designed to determine whether a preoperative immersive virtual reality tour demonstrates a reduction in emergence delirium through reducing the preoperative anxiety in children undergoing general anesthesia. METHODS: Eighty-six children were randomly allocated into either the control or virtual reality group. The control group received conventional education regarding the perioperative process. The virtual reality group watched a 4-minute virtual reality video showing the operating theater and explaining the perioperative process. Incidence and severity of emergence delirium were the main outcomes. Secondary outcomes included preoperative anxiety using modified Yale Preoperative Anxiety Scale and postoperative behavioral disturbance. RESULTS: Eighty children completed the final analysis (control group = 39, virtual reality group = 41). The incidence (risk ratio [95% CI]: 1.1 [0.5-2.8], P = 0.773) and severity of emergence delirium (mean difference [95% CI]: -0.2 [-2.7 to 2.2], P = 0.791) were similar in the two groups. After the intervention, children in the virtual reality group had a significantly lower modified Yale Preoperative Anxiety score than those in the control group (mean difference [95% CI]: 9.2 [0.3-18.2], P = 0.022). No difference was observed regarding postoperative behavioral disturbance between the two groups at postoperative 1 day (mean difference [95% CI]: -0.1 [-0.3 to 0.1], P = 0.671) and 14 day (mean difference [95% CI]: -0.0 [-0.1 to 0.0], P = 0.329). CONCLUSION: Preoperative immersive virtual reality tour of the operating theater did not reduce the incidence and severity of emergence delirium, although it was effective in alleviating preoperative anxiety in children.


Assuntos
Anestesia Geral/métodos , Ansiedade/prevenção & controle , Delírio do Despertar/prevenção & controle , Realidade Virtual , Anestesia Geral/psicologia , Ansiedade/psicologia , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos , Delírio do Despertar/psicologia , Feminino , Humanos , Masculino , Cuidados Pós-Operatórios/psicologia , Cuidados Pré-Operatórios/psicologia , Estudos Prospectivos
3.
Paediatr Anaesth ; 29(2): 144-152, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30365242

RESUMO

BACKGROUND: The perioperative period can be psychologically challenging, and children may exhibit behavioral changes following surgical anesthesia. It is unknown whether children in China have additional risk factors associated with negative behavioral changes. OBJECTIVES: The aim of this study was to investigate the incidence of behavioral changes in children after hypospadias repair surgery and to identify potential risk factors associated with negative behavioral changes. METHODS: A prospective cohort of 177 children aged 2-12 years scheduled for hypospadias repair surgery from 2016 to 2017 was studied. The primary outcome was the incidence of behavioral changes on postoperative days 14 and 30 evaluated with the Post-Hospitalization Behavioral Questionnaire. Data collected included demographic data, anesthesia details, procedure details, admission details, child anxiety, child temperament, pain, and emergence delirium. Multivariable logistic regression was used to identify risk factors associated with postoperative negative behavioral changes. RESULTS: A total of 60.5% (107/177) of children exhibited negative postoperative behavioral changes on day 14 and 46.5% (79/170) exhibited changes on day 30 after the surgery. Approximately 2.3% (4/177) and 2.4% (4/170) of children showed improved behavior on postoperative days 14 and 30, respectively. The frequency of temper tantrums changed the most. The logistic regression results suggested that a younger age (odds ratio: 0.86; 95% confidence interval 0.76-0.96), emotional temperament (odds ratio: 1.1; 95% confidence interval 1.0-1.2) and maternal education (odds ratio: 2.2; 95% confidence interval 1.1-4.5) were associated with negative postoperative behavioral changes on day 14. On day 30, a younger age (odds ratio: 0.87; 95% confidence interval 0.77 to 0.98) was the only factor associated with negative postoperative behavioral changes. CONCLUSION: For children undergoing hypospadias repair surgery in our institution, approximately three in five showed postoperative behavioral changes. In addition to a younger age and a higher maternal education, an emotional temperament is associated with a high incidence of negative postoperative behavioral changes.


Assuntos
Comportamento Infantil/psicologia , Hipospadia/psicologia , Hipospadia/cirurgia , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Anestesia Geral/psicologia , Ansiedade/psicologia , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Masculino , Período Perioperatório/psicologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Cuidados Pré-Operatórios/psicologia , Estudos Prospectivos , Inquéritos e Questionários
4.
Paediatr Anaesth ; 29(3): 226-230, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30576047

RESUMO

Children with autistic spectrum disorder are more likely to become distressed during induction of anesthesia. Inhalational induction is almost always the preferred route with acceptance of the face mask often presenting a considerable challenge. Tempering measures to facilitate gas induction such as forced premedication and physical restraint are no longer viable options except in extenuating circumstances. Recent research interest has focused on the need for advanced planning in collaboration with the caregiver to tailor an individualized perioperative plan. This plan may include both pharmacological and non-pharmacological interventions. Applied behavior analysis strategies have a well-documented efficacy in this unique population to systematically change an individual's usual behavior. These can be used, as a non-pharmacological strategy, to ensure a smooth perioperative course. We present a successful case of preoperative desensitization of a child with severe autistic spectrum disorder using a mirror demonstration technique associated with positive reinforcement to prepare him for general anesthesia. We discuss the potential application of applied behavior analysis strategies for anesthesia in this unique population. From a practical point of view, early communication with carers is required to establish who may benefit from this behavioral training. Planned individual preparation for general anesthesia must be provided by trained multidisciplinary staff.


Assuntos
Anestesia/métodos , Anestesia/psicologia , Transtorno do Espectro Autista/psicologia , Cuidadores/educação , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/psicologia , Anestesia Dentária/métodos , Anestesia Dentária/psicologia , Anestesia Geral/métodos , Anestesia Geral/psicologia , Transtorno do Espectro Autista/cirurgia , Transtorno Autístico , Criança , Humanos
5.
Niger J Clin Pract ; 21(10): 1304-1310, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30297563

RESUMO

Purpose: The study aimed to investigate dental anxiety and oral health-related quality of life among children undergoing dental rehabilitation under general anesthesia (GA) and intravenous sedation (IVS). Materials and Methods: Participants were 99 healthy children aged 3-5 or 6-12 years operated under GA or IVS. Dental anxiety before treatment and 1 month postoperatively were measured using the Frankl behavior scale (FBS), the venham picture test (VPT), the early childhood oral health impact scale (ECOHIS), and the children's fear survey schedule-dental subscale (CFSS-DS). Data were analyzed using Student's t-test and Mann-Whitney U-test. Results: ECOHIS scores decreased in all groups. VPT scores increased in the 3-5-year-olds treated under GA (P = 0.003). Postoperative CFSS-DS anxiety scores were lower in IVS groups. FBS scores were significantly higher for both age groups (P < 0.001). There was no effect of numbers of extracted or treated teeth. Conclusions: Dental rehabilitation under GA and IVS improved the quality of life and dental behavior. In the 6-12-year-olds, there was no statistically significant difference between children undergoing dental operations under GA and those undergoing dental operations under IVS. Dental anxiety decreased in 3-5-year-olds after treatment under GA but not after IVS.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Geral/efeitos adversos , Ansiedade ao Tratamento Odontológico/psicologia , Assistência Odontológica/psicologia , Cárie Dentária/psicologia , Saúde Bucal , Qualidade de Vida/psicologia , Anestesia Dentária/psicologia , Anestesia Geral/psicologia , Ansiedade/psicologia , Criança , Comportamento Infantil , Pré-Escolar , Estudos Transversais , Cárie Dentária/terapia , Restauração Dentária Permanente/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos
6.
BMC Anesthesiol ; 18(1): 134, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261837

RESUMO

BACKGROUND: The airway reflex such as cough is common accompanied with severe fluctuations of hemodynamics during emergence. This prospective double-blind randomized controlled trial tested the hypothesis that topical ropivacaine may reduce extubation response and postoperative sore throat. METHODS: Fifty-four patients undergoing thyroidectomy were randomly assigned to two groups. The patients in Group R were received 0.75% ropivacaine, which was sprayed on the tracheal mucosa, epiglottis, tongue base, and glottis to achieve uniform surface anesthesia. As control, patients in Group C were received the same volume saline. The primiary outcome was the incidence and grade of cough during peri-extubation. RESULTS: The incidence (34.62% vs. 76.92%, P = 0.002) of cough during extubation were lower in Group R compared to Group C. Meanwhile, the sore throat visual acuity score at 12 h after surgery was lower in Group R than that in Group C (2.00 vs. 3.50, P = 0.040). CONCLUSION: Topical anesthesia with 0.75% ropivacaine before intubation can significantly reduce the incidence of cough during peri-extubation. Meanwhile, it reduced hemodynamic fluctuations and postoperative throat pain without influence patients recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800014412 (date of registration January 2018).


Assuntos
Anestesia Geral/psicologia , Anestésicos Locais/administração & dosagem , Delírio do Despertar/prevenção & controle , Delírio do Despertar/psicologia , Intubação Intratraqueal/psicologia , Ropivacaina/administração & dosagem , Administração Tópica , Adulto , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Método Duplo-Cego , Delírio do Despertar/diagnóstico , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle , Hipertensão/psicologia , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
7.
Paediatr Anaesth ; 28(8): 719-725, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29962037

RESUMO

BACKGROUND: There is a large body of literature examining factors associated with children's preoperative anxiety; however, cultural variables such as ethnicity and language have not been included. AIMS: The purpose of this investigation was to examine the role of Latino ethnicity and Spanish-speaking families in pediatric preoperative anxiety. METHODS: Participants were 294 children aged 2-15 years of age undergoing outpatient, elective tonsillectomy and/or adenoidectomy surgery and general anesthesia. Participants were recruited and categorized into 3 groups: English-speaking non-Latino White (n = 139), English-speaking Latino (n = 88), and Spanish-speaking Latino (n = 67). Children's anxiety was rated at 2 time points before surgery: the time the child entered the threshold of the operating room (Induction 1) and the time when the anesthesia mask was placed (Induction 2). RESULTS: Results from separate linear regression models at Induction 1 and Induction 2, respectively, showed that being from a Spanish-speaking Latino family was associated with higher levels of preoperative anxiety compared with being from an English-speaking family. In addition, young age and low sociability was associated with higher preoperative anxiety in children. CONCLUSION: Clinicians should be aware that younger, less sociable children of Spanish-speaking Latino parents are at higher risk of developing preoperative anxiety and manage these children based on this increased risk.


Assuntos
Anestesia Geral/psicologia , Ansiedade/etnologia , Ansiedade/psicologia , Barreiras de Comunicação , Hispano-Americanos/psicologia , Adenoidectomia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Período Pré-Operatório , Tonsilectomia/psicologia , Estados Unidos
8.
Br J Anaesth ; 121(1): 233-240, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29935577

RESUMO

Selfhood is linked to brain processes that enable the experience of a person as a distinct entity, capable of agency. This framework naturally incorporates a continuum of both non-conscious and conscious self-related information processing, and includes a hierarchy of components, such as awareness of existence (core self), embodied self (sentience), executive self (agency/volition), and various other higher-order cognitive processes. Consciousness relates to, but is not congruent, with selfhood; understanding the processes required for selfhood can explain the partial consciousness seen in anaesthesia. Functional-brain-imaging and electroencephalographic studies in sleep and general anaesthesia have shown differential effects of anaesthetic drugs on various specific self-related functional brain networks. In particular, drug-induced selective impairment of anterior insula function suggests there might be a crucial difference between anaesthesia and natural sleep when it comes to the salience network. With increasing concentrations of anaesthetics, it is not uncommon for patients to become depersonalised (i.e. to lose sentience and agency), but retain many higher-order functions and a disembodied self-awareness, until quite high concentrations are reached. In this respect, general anaesthesia differs significantly from physiological sleep, where it appears that loss of agency and sentience parallels, or lags behind, the decrease in self-awareness. Interestingly, connectivity within the posterior brain regions is maintained even to quite high concentrations of anaesthetics, potentially representing a pathognomonic marker of the core self that possibly is involved in maintaining a reduced energy state of homeostasis.


Assuntos
Anestesia Geral/psicologia , Ego , Eletroencefalografia/efeitos dos fármacos , Neuroimagem , Mapeamento Encefálico , Humanos , Vigília
9.
Paediatr Anaesth ; 28(6): 547-551, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29752842

RESUMO

BACKGROUND: Preoperative fasting in children can cause anxiety, which may ultimately lead to postoperative emergence delirium. However, no data are available whether duration of preoperative fasting correlates with postoperative emergence delirium. AIMS: The aim of this study was to identify if there is any correlation between the duration of preoperative fasting and emergence delirium in children undergoing ophthalmic examination under anesthesia. METHODS: In this prospective observational study, 100 children between the age group 2-6 years of American Society of Anesthesiologists physical status I or II, scheduled for examination of the eye under general anesthesia with sevoflurane were recruited. Data regarding preoperative fasting was recorded and presence of emergence delirium was assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 minute interval till 30 minutes from the time of leaving the operation theater. No premedication was used in any patients but parental presence was allowed in all of them. RESULTS: Mean (standard deviation) duration of fasting to clear liquid was 6.3 (1.7) hrs. Twenty-four children (24%) had at least 1 recorded PAED score >10 at any time point in the postoperative period. PAED scores at 15 and 25 minutes were significantly correlated with duration of fasting (r2 [95% CI] = .24 [0.04, 0.41], P = .02, Pearsons's correlation and r2 [95% CI] = .23 [0.04, 0.41], P = .02, Pearsons's correlation, respectively). No correlation has been found between duration of fasting and blood glucose level (r2 [95% CI] = -.05 [-0.24, 0.15], P = .65, Pearsons's correlation) between fasting blood glucose and PAED score at any time point. CONCLUSION: Increased preoperative fasting duration may be a risk factor for postoperative emergence delirium in children undergoing ophthalmic examination under general anesthesia.


Assuntos
Anestesia Geral/psicologia , Delírio do Despertar/epidemiologia , Delírio do Despertar/psicologia , Oftalmopatias/terapia , Jejum/efeitos adversos , Período Pré-Operatório , Período de Recuperação da Anestesia , Criança , Pré-Escolar , Jejum/psicologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
10.
Eur J Paediatr Dent ; 19(2): 139-144, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29790778

RESUMO

AIM: Treatment under general anaesthesia (DGA) is a rising trend in Finland. There is a great need to investigate the causes leading to it. Our purpose was to examine family-related factors reported by parents, such as the family size and favoring DGA in the family, and their influence on children being treated under DGA. This survey was based on a questionnaire targeted to parents of children whose dental treatment could not be performed in a conventional setting. MATERIALS AND METHODS: Guardians of 87 healthy children treated under DGA at a municipal health center in the city of Oulu, Finland, between November 2014 and December 2015 answered the questionnaire on family-related background factors and on the respondent's own as well as their child's presumed dental fear. RESULTS: According to most guardians (83.9% of the cases), the reason for DGA was caries. Male gender, vague family structure, large number of siblings (?4), and DGA history in the family were all important family-related background factors leading to DGA. Self-reported parental dental fear was quite common (25.3%). Children's dental fear reported by parents was associated with DGA in almost half of the cases (46.0%). CONCLUSIONS: The survey highlights the role of the entire family in association with children ending up being treated under DGA. It is essential for the success of dental health care to also consider family-related factors when planning the treatment, particularly with children demanding DGA.


Assuntos
Anestesia Dentária/psicologia , Anestesia Geral/psicologia , Assistência Odontológica para Crianças/psicologia , Pais/psicologia , Criança , Ansiedade ao Tratamento Odontológico/psicologia , Feminino , Finlândia , Humanos , Masculino , Inquéritos e Questionários
12.
J Perianesth Nurs ; 33(6): 822-833, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29548667

RESUMO

PURPOSE: To examine anxiety and what older patients worry about related to anesthesia and colorectal surgery, and their perceptions regarding nurses' ability to ease preoperative worry. DESIGN: Qualitative individual face-to-face interviews. METHODS: The study included 18 patients aged between 62 and 91 years with lower abdominal tumors. The study was conducted in two day-surgery wards in Sweden. Interview data were analyzed with Malterud's systematic text condensation. FINDINGS: Four themes were identified: (1) losing control of one's body, leaving one's life in someone else's hands, and the feeling that there is no going back, (2) claustrophobia and anticipated pain in an unknown environment, (3) unknown and frightening vocabulary concerning the surgery, and (4) what can happen if something goes wrong. CONCLUSIONS: Patients worry about a number of things. If preoperative worry could be identified, actions taken to reduce worry could be personalized and patients' own strategies to reduce worries may be helpful for them.


Assuntos
Anestesia Geral/métodos , Ansiedade/epidemiologia , Neoplasias Colorretais/cirurgia , Transtornos Fóbicos/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Período Pré-Operatório , Estudos Prospectivos , Pesquisa Qualitativa , Suécia
13.
J Pediatr Surg ; 53(8): 1606-1610, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29455886

RESUMO

INTRODUCTION: Parental presence at induction of general anesthesia (PPI) is highly desired by children and parents. However, it often faces resistance from medical personnel. We conducted a survey evaluating the perceptions of surgeons before and after establishment of a PPI program. METHODS: Internal web-based surveys using Likert Scale questions were administered to all members of a pediatric surgical department before and after the introduction of PPI at a freestanding children's hospital. Pre and post results were compared by Wilcoxon rank-sum tests. A p-value ≤0.0026 was considered significant due to the Bonferroni correction. RESULTS: The survey was sent to 59 surgeons 1year before and 5years after gradual implementation of PPI. Response rates were 46% and 54%, pre and post implementation, respectively. After implementation, there was a statistically significant increased level of agreement with the statement: "PPI improves the parents' level of satisfaction" (p=0.0025) and a statistically significant decreased level of agreement with the statement "PPI lengthens the duration of induction" (p=0.0001). Before initiation, 56% wanted to see PPI implemented, while after implementation, 97% wanted PPI to remain. CONCLUSIONS: A majority of pediatric surgeons favored maintaining PPI after implementation. Resistance to initiation of PPI should not hinder implementation. TYPE OF STUDY: Survey LEVEL OF EVIDENCE: Not applicable.


Assuntos
Anestesia Geral/psicologia , Implementação de Plano de Saúde , Pais/psicologia , Cooperação do Paciente/psicologia , Cuidados Pré-Operatórios/métodos , Anestesia Geral/métodos , Ansiedade/prevenção & controle , Criança , Feminino , Humanos , Relações Pais-Filho , Inquéritos e Questionários
14.
Paediatr Anaesth ; 28(2): 157-166, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29280239

RESUMO

BACKGROUND: Family-centered interactive on-line games are increasingly popular in healthcare, but their effectiveness for preoperative preparation needs further research. www.scottga.org is the new on-line version of a proven nonweb-based game for children and parents/caregivers. AIMS: The aim of this study was to evaluate if www.scottga.org improved children's anxiety and families' satisfaction compared with controls. METHODS: In this phase III double-blind randomized controlled trial, children/parents/caregivers received (i) www.scottga.org, (ii) standard care, or (iii) a placebo hand-washing game. The intervention and placebo games were available online for home usage and provided again on the ward before surgery. All children were accompanied by parent/caregivers at induction and observed and scored using validated measures. Stratified randomization and generalized linear models were used. An intention-to-treat approach was adopted. RESULTS: Overall, 52/176 children had baseline "psychological disturbance." Children's anxiety increased preinduction, but there were no differences between groups (Facial Image Scale: video-standard OR = 1.08, P = .82, 95% CI [0.56, 2.1]; video-placebo OR = 0.9, P = .77 95% CI [0.46, 1.8]). There were no differences in induction behavior (visual analog scale: video mean = 3.5; standard care mean = 3.5; placebo mean = 3.7: video-standard OR = 2.0, P = .42, 95% CI [-0.6, 1.3]; video-placebo OR = 1.53, P = .65, 95% CI [-0.8, 1.1]) or induction anxiety (modified Yale Preoperative Anxiety Scale: video-standard OR 1.02, P = .97, 95% CI [0.61, 2.6]; video-placebo OR 1.38, P = .49, 95% CI [0.87, 3.81]). Families favored the intervention regarding the "child handling the visit better" (Treatment Evaluation Inventory: video-standard OR = 12; 95% CI 4.7-32; P < .001; video-placebo OR = 8.2; 95% CI 3-22; P < .001) and "improving the child's ability to cope" (Treatment Evaluation Inventory: video-standard OR = 21; 95% CI 8-56; P < .001 and video-placebo OR = 13; 95% CI 5-34; P < .001). CONCLUSION: Families believed that a video-game preparation helped their child's perioperative anxiety, but there were no objective measures of behavioral improvement associated with this intervention.


Assuntos
Anestesia Geral/psicologia , Ansiedade/prevenção & controle , Internet , Cuidados Pré-Operatórios/métodos , Extração Dentária/psicologia , Jogos de Vídeo , Ansiedade/psicologia , Criança , Comportamento Infantil/psicologia , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Londres , Masculino , Pais/psicologia
15.
Paediatr Anaesth ; 28(2): 149-156, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29266767

RESUMO

BACKGROUND: The Sprint National Anaesthesia Project reported feedback from adults but not from children. We developed questionnaires for children and parents, and conducted a survey of perioperative anesthetic experiences in a large pediatric hospital. METHODS: Patients undergoing elective general anesthesia were selected randomly each weekday over 10 weeks. Parents and children were approached within 4 hours after awakening, and were asked to complete a short questionnaire. Personal or patient identifiable data were not collected. Questionnaires were processed by optical mark reading technology and descriptive data analysis was performed. RESULTS: Seven hundred and forty parents and 250 children completed questionnaires. The most common symptoms reported by parents were thirst and hunger (76%), drowsiness (75%), sore throat (41%), and pain of the surgery (38%). Sixty-four percent of children felt worried or scared about something before the procedure: common worries were about the "anesthetic," "procedure," or "needles/cannula." Fifty-five percent reported postoperative pain. Thirty-nine children (15.6%) remembered something between going to sleep and waking up although distress was not reported; of these, the most common experiences remembered included hearing voices (34%), feeling sore (20%), and being worried (14%). Twenty-two parents (2.9%) had any complaint and most were about fasting instructions. Only 3 parents would not recommend the anesthetic service. CONCLUSION: This study shows that the experiences of children and their parents are similar to those of adults reported by the Sprint National Anaesthesia Project. Thirst (and hunger), anxiety, and pain continue to be common problems for many children. This feedback may help direct interventions and research to improve the pediatric patient and parent experience with anesthesia.


Assuntos
Anestesia Geral/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pais , Inquéritos e Questionários , Reino Unido/epidemiologia
16.
BMC Anesthesiol ; 17(1): 167, 2017 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-29216820

RESUMO

BACKGROUND: Surgical stress index (SSI) is an established indicator for intraoperative nociception. Opioids are used to block stimulus of cranial pinning in neurosurgery. We investigated the effect of different infusion rates of sufentanil on SSI during cranial pinning in children under general anaesthesia. METHODS: Forty-nine children (2-12 years of age) underwent neurosurgery with pinning. The children were randomized into three groups based on the rate of sufentanil infusion: 0.2, 0.5, and 0.8 µg·kg-1·hr.-1. Continuous sufentanil infusion began following neuromuscular blockade administration, at a rate determined by each patient's assigned treatment group. Following preparation for surgery, cranial pinning was performed. Systolic, diastolic, and mean blood pressures, along with heart rate and photoplethysmographic data, were continuously recorded from 1 min prior to cranial pinning through 5 min after cranial pinning, in 1-min intervals. SSI was calculated following the completion of surgery. Differences in measured outcomes over time among the three groups were evaluated using a generalized estimation equation. Differences in pinning outcomes in the same group were evaluated with Freidman test. RESULTS: We found no statistical differences in long-term SSI that were associated with different infusion rates of sufentanil during cranial pinning. Blood pressures in all groups increased for 2 min after cranial pinning, and then decreased; we found no statistical difference in long-term blood pressure values among the groups. Heart rate increased after pinning in the group that received a low-dose infusion of sufentanil. CONCLUSIONS: Since SSI was intended to measure the blunting effects of sufentanil towards the noxious stimulus of cranial pinning, our results suggest that SSI might not be sufficiently sensitive to monitor the nociceptive response in children. TRIAL REGISTRATION: ( KCT0000978 , Jan-07, 2014).


Assuntos
Anestesia Geral/métodos , Anestésicos Intravenosos/administração & dosagem , Pinos Ortopédicos , Procedimentos Neurocirúrgicos/métodos , Estresse Psicológico/tratamento farmacológico , Sufentanil/administração & dosagem , Anestesia Geral/psicologia , Pinos Ortopédicos/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos/psicologia , Crânio/cirurgia , Estresse Psicológico/psicologia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 96(42): e6428, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29049165

RESUMO

The purpose of the study was to investigate the effects of total intravenous anesthesia (TIVA) and combined of intravenous and inhaled anesthesia (CIIA) on intraoperative awareness in surgical patients.A total of 678 patients were recruited in the CIIA group, while TIVA group included 566 patients. The clinical characteristics and the occurrence of intraoperative awareness were compared between the groups. Mini-Mental State Examination, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 tests were performed to estimate cognitive and psychological functions of the patients. In addition, logistic regression analysis was applied to identify the risk factors for intraoperative awareness in surgical patients.In CIIA group, 3 patients (0.44%) were confirmed with intraoperative awareness, while 11 patients (1.94%) in TIVA group underwent intraoperative awareness. The occurrence rate of intraoperative awareness was significantly higher in VITA group than that in the CIIA group (P = .029). Awareness classification demonstrated that intraoperative awareness mainly included auditory, tactile, and pain perceptions. Moreover, 4 patients showed distress after operation. Patients with intraoperative awareness exhibited poor performance in cognitive and psychological tests (P < .001 for all). Logistic regression analysis demonstrated that CIIA (odds ratio [OR] = 0.198, 95% confidence interval [CI] = 0.047-0.827), age (OR = 0.951, 95% CI = 0.908-0.997), midazolam application (OR = 0.158, 95% CI = 0.034-0.736), awareness history (OR = 10.131, 95% CI = 2.206-45.517), and duration of surgery (OR = 1.016, 95% CI = 1.001-1.032) were significantly associated with intraoperative awareness.Intraoperative awareness can significantly influence the cognitive and psychological functions of surgical patients. CIIA and midazolam application may lower the risk of intraoperative awareness.


Assuntos
Anestesia Geral/efeitos adversos , Anestesia Geral/psicologia , Consciência no Peroperatório/psicologia , Complicações Pós-Operatórias/psicologia , Estresse Psicológico/psicologia , Adulto , Anestesia Geral/métodos , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/psicologia , Anestesia Intravenosa/efeitos adversos , Anestesia Intravenosa/psicologia , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Éteres Metílicos/administração & dosagem , Éteres Metílicos/efeitos adversos , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/induzido quimicamente , Período Pós-Operatório , Propofol/administração & dosagem , Propofol/efeitos adversos , Sevoflurano , Estresse Psicológico/induzido quimicamente , Resultado do Tratamento
19.
Ann Acad Med Singapore ; 46(6): 248-251, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28733690

RESUMO

There are various modes of anaesthesia available in the community today. This gives anaesthesiologists the freedom to select those that are safe, efficacious and most suitable for patients. However, patients may not always agree with their anaesthesiologist on the preferred mode of anaesthesia because they may have a different set of priorities, with many of them electing to have the lack of intraoperative awareness as the primary objective. Hence, disagreements between anaesthesiologists and patients may arise and could potentially disrupt doctor-patient relationship. This paper attempts to explore the possible reasons for obstetric patients championing for certain modes of anaesthesia and to provide an insight into the need for adequate patient education.


Assuntos
Anestesia Geral , Anestesia Obstétrica , Procedimentos Cirúrgicos Obstétricos , Preferência do Paciente/psicologia , Relações Médico-Paciente/ética , Anestesia Geral/métodos , Anestesia Geral/psicologia , Anestesia Obstétrica/métodos , Anestesia Obstétrica/psicologia , Estado de Consciência , Humanos , Procedimentos Cirúrgicos Obstétricos/ética , Procedimentos Cirúrgicos Obstétricos/métodos , Procedimentos Cirúrgicos Obstétricos/psicologia , Educação de Pacientes como Assunto
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