Preoperative Anxiety Management

Mapping Intimacies ◽

10.1093/med/9780190678333.003.0001 ◽

2018 ◽

Author(s):

Thomas L. Shaw

Keyword(s):

Operating Room ◽

Emotional Distress ◽

Behavioral Interventions ◽

Hospital Setting ◽

Preoperative Anxiety ◽

Perioperative Outcomes ◽

Anxiety Management

Children presenting for surgery are often significantly more anxious compared to adults. This may occur during a new exposure to an unfamiliar environment or repeat exposures to the hospital setting. Pediatric anesthesiologists must utilize a variety of creative and traditional and nontraditional strategies to help alleviate this feeling of anxiety prior to proceeding to the operating room. Knowledge of the consequences of preoperative emotional distress, combined with knowledge of available pharmacological and behavioral interventions, can help enhance the patient’s and the parents’ experience, as well as perioperative outcomes. Both pharmacologic and nonpharmacologic strategies have been successfully utilized perioperatively.

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Preoperative distraction in children: hand-held videogames vs clown therapy

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2014.98 ◽

2014 ◽

Vol 36 (5-6) ◽

Cited By ~ 11

Author(s):

M. Messina ◽

F. Molinaro ◽

D. Meucci ◽

R. Angotti ◽

L. Giuntini ◽

...

Keyword(s):

Hospital Stay ◽

Emotional Distress ◽

Nocturnal Enuresis ◽

Sleep Disturbances ◽

Life Quality ◽

Preoperative Anxiety ◽

Feeding Disorders ◽

Behavioural Interventions ◽

Therapeutic Goals ◽

Children And Parents

Anxiety in children undergoing surgery is characterized by feelings of tension, apprehension, nervousness and fear which may manifest differently. Postoperative behavioural changes such as nocturnal enuresis, feeding disorders, apathy, and sleep disturbances may stem from postoperative anxiety. Some Authors pointed out that over 60% of children undergoing surgery are prone to developing behavioural alterations 2 weeks after surgery. Variables such as age, temperament and anxiety both in children and parents are considered predictors of such changes.1 Studies were published describing how psycho-behavioural interventions based on play, learning and entertainment in preparing children for surgery, may reduce preoperative anxiety. Clown-therapy is applied in the most important paediatric facilities and has proved to diminish children’s emotional distress and sufferance, as well as consumption of both analgesics and sedatives and to facilitate the achievement of therapeutic goals. The aim of our study was to evaluate the efficacy of clown-therapy during the child’s hospital stay, with a view to optimizing treatment and care, preventing behavioural alterations and enhancing the child’s overall life quality.

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Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program Pediatric database analysis

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.1.peds15674 ◽

2016 ◽

Vol 18 (4) ◽

pp. 416-422 ◽

Cited By ~ 16

Author(s):

Jacob Cherian ◽

Kristen A. Staggers ◽

I-Wen Pan ◽

Melissa Lopresti ◽

Andrew Jea ◽

...

Keyword(s):

Quality Improvement ◽

Operating Room ◽

Defect Size ◽

Quality Improvement Program ◽

Perioperative Outcomes ◽

Wound Complications ◽

Unplanned Readmission ◽

Improvement Program ◽

Surgical Quality ◽

Myelomeningocele Repair

OBJECTIVE Due to improved nutrition and early detection, myelomeningocele repair is a relatively uncommon procedure. Although previous studies have reviewed surgical trends and predictors of outcomes, they have relied largely on single-hospital experiences or on databases centered on hospital admission data. Here, the authors report 30-day outcomes of pediatric patients undergoing postnatal myelomeningocele repair from a national prospective surgical outcomes database. They sought to investigate the association between preoperative and intraoperative factors on the occurrence of 30-day complications, readmissions, and unplanned return to operating room events. METHODS The 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (NSQIP-P) was queried for all patients undergoing postnatal myelomeningocele repair. Patients were subdivided on the basis of the size of the repair (< 5 cm vs > 5 cm). Preoperative variables, intraoperative characteristics, and postoperative 30-day events were tabulated from prospectively collected data. Three separate outcomes for complication, unplanned readmission, and return to the operating room were analyzed using univariate and multivariate logistic regression. Rates of associated CSF diversion operations and their timing were also analyzed. RESULTS A total of 114 patients were included; 54 had myelomeningocele repair for a defect size smaller than 5 cm, and 60 had repair for a defect size larger than 5 cm. CSF shunts were placed concurrently in 8% of the cases. There were 42 NSQIP-defined complications in 31 patients (27%); these included wound complications and infections, in addition to others. Postoperative wound complications were the most common and occurred in 27 patients (24%). Forty patients (35%) had at least one subsequent surgery within 30 days. Twenty-four patients (21%) returned to the operating room for initial shunt placement. Unplanned readmission occurred in 11% of cases. Both complication and return to operating room outcomes were statistically associated with age at repair. CONCLUSIONS The NSQIP-P allows examination of 30-day perioperative outcomes from a national prospectively collected database. In this cohort, over one-quarter of patients undergoing postnatal myelomeningocele repair experienced a complication within 30 days. The complication rate was significantly higher in patients who had surgical repair within the first 24 hours of birth than in patients who had surgery after the 1st day of life. The authors also highlight limitations of investigating myelomeningocele repair using NSQIP-P and advocate the importance of disease-specific data collection.

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A prospective randomised study on efficacy of music for decreasing preoperative anxiety in children

Journal of Perioperative Practice ◽

10.1177/1750458920939780 ◽

2020 ◽

pp. 175045892093978

Author(s):

Cynthia V Nguyen ◽

Madeleine Alvin ◽

Carol Lee ◽

Darrell George ◽

Allison Gilmore ◽

...

Keyword(s):

Heart Rate ◽

Operating Room ◽

Heart Rate Change ◽

Preoperative Anxiety ◽

Patient Choice ◽

Rate Change ◽

Waiting Room ◽

Randomised Study ◽

Music Medicine ◽

Significant Difference

Background The operating room can be a frightening environment for paediatric patients. This study investigated whether music medicine can mitigate preoperative anxiety in children. Materials and methods One hundred and fifty children undergoing general anaesthesia were randomised to listen to music of the child’s choice, lullaby music or no music before induction. Heart rates were measured in the waiting room, upon first entry into the operating room and just prior to induction. Results There was no significant difference in average heart rate change from the waiting room to induction in the patient choice, lullaby and control groups. Older age was associated with higher heart rate changes between baseline and entering the operating room. Pharmacologic sedation showed a significant beneficial effect on heart rate change at induction. Conclusion Use of music medicine in the operating room does not show efficacy to reduce anxiety in children based on heart rate changes.

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Safety of Achilles Repair Using the Mini-Open Approach in Supine Position vs Prone Position: A Retrospective Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00235 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0023

Author(s):

James Rush Jones ◽

Haley McKissack ◽

Aaradhana J. Jha ◽

Leonardo V. M. Moraes ◽

Jun Kit He ◽

...

Keyword(s):

Achilles Tendon ◽

Operating Room ◽

Prone Position ◽

Supine Position ◽

Surgical Repair ◽

Traditional Approach ◽

Perioperative Period ◽

Perioperative Outcomes ◽

Open Approach ◽

Mini Open

Category: Sports Introduction/Purpose: Surgical repair of the Achilles tendon is a commonly-performed procedure in cases of acute tendon rupture. Open Achilles tendon surgery with traditional extensile approach is most often performed with the patient in prone position, but this can interfere with airway access, put increased pressure on the abdomen, and subject to increase perioperative period and comorbidities. Mini-open approach in supine repair may potentially avoid the risks of the prone position, but the safety and utility of this approach have not been established. The purpose of this study is to compare perioperative outcomes between patients undergoing acute Achilles rupture repair with mini-open approach in the supine position versus traditional approach in the prone position. Methods: Patients who underwent surgical repair of acute Achilles rupture between the years 2011 and 2018 at a single institution were retrospectively identified using CPT code 27650. Patients who underwent concurrent procedures for additional injuries were excluded. Charts of included patients were retrospectively reviewed for demographic information, intraoperative characteristics, and postoperative outcomes. Statistical analysis was conducted and p-values =0.05 were considered significant. Results: A total of 81 patients were included for analysis, 26 supine and 55 prone. Baseline characteristics were statistically similar between the two groups. Average total time in the operating room was significantly greater among patients in the prone position (118.7 minutes) than those in the supine position (100 minutes) (p = 0.0011). Average surgery time, blood loss, and time in PACU were greater among the prone group than the supine group, although these differences were not statistically significant. Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and DVT rate were also similar between the two groups. Conclusion: The mini open approach in supine position may be advantageous in repair of acute Achilles rupture in that it significantly reduces total time in the operating room while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.

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Effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension: A randomized controlled trial

Clinical and Experimental Hypertension ◽

10.1080/10641963.2020.1723619 ◽

2020 ◽

Vol 42 (6) ◽

pp. 553-558 ◽

Cited By ~ 3

Author(s):

Nureddin Yuzkat ◽

Celaleddin Soyalp ◽

Omer Turk ◽

Siddik Keskin ◽

Nurcin Gulhas

Keyword(s):

Randomized Controlled Trial ◽

Operating Room ◽

Controlled Trial ◽

Preoperative Anxiety ◽

Randomized Controlled

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Interventions for Parental Anxiety in Preparation for Pediatric Surgery: A Narrative Review

Children ◽

10.3390/children8111069 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1069

Author(s):

Pooja Santapuram ◽

Amanda L. Stone ◽

Rachel Lane Walden ◽

Louise Alexander

Keyword(s):

Emotional Response ◽

Pediatric Patients ◽

Preoperative Anxiety ◽

Perioperative Outcomes ◽

Parental Anxiety ◽

Negative Effects ◽

Preparation Programs ◽

Pediatric Anxiety ◽

Downstream Effects ◽

Effects On Children

The preoperative experience can cause significant anxiety for both pediatric patients and their parents in the lead up to a surgical procedure. Pediatric anxiety in a preoperative setting has been shown to have significant negative downstream effects on the clinical outcomes of children and the healthcare system as a whole. Studies have found that preoperative parental anxiety has significant negative effects on children, regarding anxiety and emotional response. Therefore, interventions for parental preoperative anxiety are important to reduce the child’s anxiety. This review provides a brief overview of a broad range of strategies used to alleviate parental anxiety in a preoperative setting. Preoperative education, play-based interventions, music therapy, the presence of parents at induction of anesthesia, and integrative preoperative preparation programs have all demonstrated some evidence for reducing parental preoperative anxiety. The ultimate goal of using interventions for parental preoperative anxiety is to equip healthcare systems to better support families and optimize the perioperative outcomes of children.

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Improving surgical safety checklist completion using distributed responsibility of checklist item completion among operating room team members: A quality improvement project

University of Ottawa Journal of Medicine ◽

10.18192/uojm.v10i1.4630 ◽

2020 ◽

Vol 10 (1) ◽

pp. 40-46

Author(s):

Mehr Jain

Keyword(s):

Operating Room ◽

Intervention Group ◽

Perioperative Outcomes ◽

Checklist Item ◽

Improvement Project ◽

Team Members ◽

Surgical Safety Checklist ◽

Surgical Safety ◽

Operating Room Team ◽

Questions And Responses

Background. Surgical safety checklists are a standard of care for safe operating room practice, but their use has not been associated with reductions in adverse perioperative outcomes in some settings. Non-adherence and partial checklist completion may contribute to this lack of effect. Objective. To examine whether a surgical safety checklist using distributed responsibility of checklist item completion, by allocation of questions and responses among operating room staff, increases surgical safety checklist compliance. Methods. With Quality and Risk Management approval, a multicomponent strategy consisting of novel surgical safety checklist focused on distributed responsibility of checklist item completion was evaluated in orthopaedic operating rooms at The Hospital for Sick Children, Toronto, from July to August 2016 using a before-and-after study design. The intervention consisted of a wall-mounted reusable checklist with questions and responses designated to specific operating room team members. Team training was provided beforehand, operating room team leaders were identified to promote the intervention, and revisions to the checklist content and process were implemented based on feedback on feasibility and clinical sensibility. Results. A total of 45 and 59 children were included in pre-intervention and intervention groups, respectively. Overall, 87% (1,354/1,560) of checklist items were observed. Checklist item completion was significantly increased in the post-intervention group (77% [615/802]) compared with the pre-intervention group (27% [150/522]) (P<0.001). Conclusions. These findings suggest that a multicomponent strategy of designating responsibility for item completion among operating room team members and using a memory aid can improve compliance with surgical safety checklist item completion.

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