Pre-operative Anxiety in Pediatric Surgery Patients: Multiple Case Study Analysis with Literature Review
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Pre-operative Anxiety in Pediatric Surgery Patients: Multiple Case Study Analysis with Literature Review Emily Fronk 1
& Stephen Bates Billick
1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Pre-operative anxiety affects millions of pediatric surgery patients each year and can have both short and long-term adverse effects in the post-operative period. As a result, it is particularly important for healthcare providers and others involved in the child’s care, such as the parents, to be aware of interventions that can be used to reduce the onset of pre-operative anxiety and, thus, the likelihood of negative post-operative changes. The purpose of this paper is to familiarize the reader with the issue of pre-operative anxiety through a review of the literature and analysis of case studies. First, the paper looks at the causes of pre-operative anxiety and its effect on the development of maladaptive behavioral, emotional, and physiological changes. It then discusses the ways pre-operative anxiety can be measured and current methods for reducing the post-operative adverse outcomes associated with it. After doing so, it proposes the need for additional research and the use of precision medicine by physicians. Keywords Pre-operative anxiety . Pediatric surgery . Anxiolytic interventions . Pediatric psychiatry
Introduction Each year, more than five million children in the United States alone undergo surgery [1]. Even when minor and routine, surgery can be a significant source of distress for children, resulting in pre-operative anxiety [2, 3]. Pre-operative anxiety typically occurs on the day of surgery, peaking during the induction of anesthesia [4]. Children are particularly susceptible to preoperative anxiety due to their limited cognitive capabilities, greater dependence on others, and * Emily Fronk [email protected] Stephen Bates Billick [email protected]
1
Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY 10016, USA
Psychiatric Quarterly
poor understanding of the health care system [3, 5, 6]. As a result, it has been found that up to 75% of pediatric surgery patients experience this anxiety [7]. Due to their developmental level, children often use behavior, rather than words, to communicate their emotions [8]. With pre-operative anxiety, this often results in demonstrations of aggression, lack of cooperation, withdrawal, and regression [8]. For example, children may spontaneously urinate, have increased muscle tone, and attempt to escape from the medical staff [5, 9]. As a result, physical restraint to hold down the child, which has been shown to actually increase stress levels for both the child and medical personnel, is required during the induction of anesthesia in around 25% of pediatric surgery cases [10].
Causes of Pre-Operative Anxiety Overall, pre-operative anxiety typically stems from perceived lack of control, worry about the “unknowns” of surgery, and fear of needles and anesthesia [11]. Younger child
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