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1.
Anesth Analg ; 129(4): 1118-1123, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295177

RESUMO

BACKGROUND: Unconscious racial bias in anesthesia care has been shown to exist. We hypothesized that black children may undergo inhalation induction less often, receive less support from child life, have fewer opportunities to have a family member present for induction, and receive premedication with oral midazolam less often. METHODS: We retrospectively collected data on those <18 years of age from January 1, 2012 to January 1, 2018 including age, sex, race, height, weight, American Society of Anesthesiologists (ASA) physical status, surgical service, and deidentified anesthesiology attending physician. Outcome data included mask versus intravenous induction, midazolam premedication, child life consultation, and family member presence. Racial differences between all outcomes were assessed in the cohort using a multivariable logistic regression model. RESULTS: A total of 33,717 Caucasian and 3901 black children were eligible for the study. For the primary outcome, black children 10-14 years were 1.3 times more likely than Caucasian children to receive mask induction (adjusted odds ratio [AOR], 1.3; 95% confidence interval [CI], 1.1-1.6; P = .001). Child life consultation was poorly documented (<0.5%) and not analyzed. Black children <15 years of age were at least 31% less likely than Caucasians to have a family member present for induction (AOR range, 0.4-0.6; 95% CI range, 0.31-0.84; P < .010). Black children <5 years of age were 13% less likely than Caucasians to have midazolam given preoperatively (AOR, 0.9; 95% CI, 0.8-0.9; P = .012). CONCLUSIONS: This study suggests that disparities in strategies for mitigating anxiety in the peri-induction period exist and adultification may be 1 cause for this bias. Black children 10 to 14 years of age are 1.3 times as likely as their Caucasian peers to be offered inhalation induction to reduce anxiety. However, black children are less likely to receive premedication with midazolam in the perioperative period or to have family members present at induction. The cause of this difference is unclear, and further prospective studies are needed to fully understand this difference.


Assuntos
Afro-Americanos , Anestesia Geral , Ansiedade/prevenção & controle , Grupo com Ancestrais do Continente Europeu , Disparidades em Assistência à Saúde/etnologia , Procedimentos Cirúrgicos Operatórios , Administração Oral , Adolescente , Comportamento do Adolescente/etnologia , Fatores Etários , Anestesia Geral/efeitos adversos , Anestesia Geral/psicologia , Ansiolíticos/administração & dosagem , Ansiedade/etnologia , Ansiedade/psicologia , Criança , Comportamento Infantil/etnologia , Feminino , Humanos , Masculino , Midazolam/administração & dosagem , Pré-Medicação , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/psicologia
2.
JAMA Netw Open ; 2(6): e195614, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31173131

RESUMO

Importance: Preoperative anxiety is associated with poor behavioral adherence during anesthetic induction and adverse postoperative outcomes. Research suggests that temperament can affect preoperative anxiety and influence its short- and long-term effects, but these associations have not been systematically examined. Objective: To examine the associations of temperament with preoperative anxiety in young patients undergoing surgery. Data Sources: Studies from MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched from database inception to June 2018. Study Selection: All prospective studies reporting associations of temperament with preoperative anxiety were included. Overall, 43 of 5451 identified studies met selection criteria. Data Extraction and Synthesis: Using the PRISMA guidelines, reviewers independently read 43 full-text articles, extracted data on eligible studies, and assessed the quality of each study. Data were pooled using the Lipsey and Wilson random-effects model. Main Outcomes and Measures: Primary outcome was the association of temperament with preoperative anxiety in patients undergoing surgery. Results: A total of 23 studies, with 4527 participants aged 1 to 18 years, were included in this review. Meta-analysis of 12 studies including 1064 participants revealed that emotionality (r = 0.11; 95% CI, 0.04 to 0.19), intensity of reaction (r = 0.29; 95% CI, 0.11 to 0.46), and withdrawal (r = 0.40; 95% CI, 0.23 to 0.55) were positively associated with preoperative anxiety, whereas activity level (r = -0.23; 95% CI, -0.31 to -0.16) was negatively correlated with preoperative anxiety. Impulsivity was not significantly associated with preoperative anxiety. Conclusions and Relevance: This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies. Future studies should continue to explore temperament and other factors influencing preoperative anxiety and their transactional effects to guide the development of precision treatment approaches and to optimize perioperative care.


Assuntos
Anestesia Geral/psicologia , Ansiedade , Cooperação do Paciente/psicologia , Procedimentos Cirúrgicos Operatórios/psicologia , Temperamento , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Medicina de Precisão , Cuidados Pré-Operatórios
3.
Clin Radiol ; 74(6): 488.e17-488.e23, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30954235

RESUMO

AIM: To assess if a child-assessment checklist covering tasks children are expected to perform during magnetic resonance imaging (MRI) can determine whether the child requires general anaesthesia (GA) during MRI. MATERIALS AND METHODS: In this institute review board approved study, children who underwent MRI from September 2016 to June 2017 at KK Women's and Children's Hospital were assessed using a checklist by a research assistant before their examination. During this project, the checklist had no influence on whether the MRI was performed under GA or not. The checklist consisted of five items rated on a binary scale assessing the child's behaviour. Binary logistic regression was performed separately on the overall sample and for a subset of younger children to identify variables associated with the requirement for GA. RESULTS: The mean age of the overall sample (798 children) and the subset of children <8 years (124 children) were 11.7±3.7 and 5.5±1.3 years, respectively. In both groups, children who required GA were significantly younger than those who did not (p<0.001). No gender differences were observed. Children who required GA scored higher on the checklist compared to those who did not in both groups (p<0.001). The diagnostic accuracy of the checklist was found to be good (area under the curve [AUC]=0.97 for both groups), with a suggested cut-off score of 4. Intraclass correlation coefficient of the ratings by two independent individuals was 0.78. CONCLUSION: The child assessment checklist was useful in identifying GA requirement in children undergoing MRI and can be administered by non-medical staff with good inter-rater reliability.


Assuntos
Anestesia Geral/psicologia , Lista de Checagem/métodos , Comportamento Infantil/psicologia , Imagem por Ressonância Magnética/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
4.
Rev Esp Anestesiol Reanim ; 66(4): 199-205, 2019 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30635114

RESUMO

INTRODUCTION AND OBJECTIVES: Regional anaesthesia (RA) has gained popularity due to its numerous benefits and increasing safety. Yet, often patients refuse this procedure and prefer general anaesthesia (GA). This study aimed to investigate variables (demographic factors, safety perception of GA and RA, patients' fears, anxiety, and knowledge) related to patients' anaesthetic preference. MATERIAL AND METHODS: Participants were patients aged 18 years or more proposed to an anaesthesia appointment for preoperative assessment. Patients completed a written questionnaire before meeting the anaesthesiologist. The questionnaire asked about their preferences, fears and perceptions about RA. RESULTS: One hundred and 2patients agreed to participate. Mean age was 52.6±13.5 years, 57.8% were female and 44.5% had at least 12 years of education. Given the choice, 54.0% would prefer GA and 20.7% said they would refuse RA if proposed by the anaesthesiologist. Among patients who already experienced neuroaxial anaesthesia, 40.0% said they did not wish to repeat it. Patients who preferred GA over RA perceived GA to be safer than RA and expressed more anxiety towards being awake during surgery and more fear of feeling pain during surgery, of having back pain, and of needle puncture. Results also suggested that patients are unaware of RA's real risks and benefits. CONCLUSIONS: Knowing patients' fears is essential for the anaesthesiologist address their patients' needs. Anaesthesiologists should work on improving general population perspective and knowledge about RA.


Assuntos
Anestesia por Condução/psicologia , Anestesia Geral/psicologia , Preferência do Paciente , Adulto , Anestesia por Condução/efeitos adversos , Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Ansiedade/psicologia , Escolaridade , Medo , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Recusa do Paciente ao Tratamento/psicologia
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
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
12.
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
13.
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
14.
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
16.
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
17.
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
18.
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
19.
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
20.
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
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