Anesth Pain Med.  2016 Jan;11(1):55-63. 10.17085/apm.2016.11.1.55.

Pharmacological and non-pharmacological interventions to alleviate anxiety before pediatric anesthesia: a survey of current practice in Korea

• Kang HE
• Jung SM
• Park S

• KMID: 2169074
• DOI: http://doi.org/10.17085/apm.2016.11.1.55

Abstract

BACKGROUND
This study was undertaken to determine current practice for preoperative anxiety reduction in Korean children.
METHODS
An email survey of all members (n = 158) of the Korean Society of Pediatric Anesthesiologists was conducted from November 2014 to January 2015 to assess current practice, preferences, and general opinions regarding pharmacological and non-pharmacological interventions performed to alleviate preoperative anxiety in children prior to general anesthesia.
RESULTS
Forty-one anesthesiologists completed the survey; a response rate of 26%. Only 4.9% of respondents undertook anxiety reduction according to a written hospital policy, and 95.1% did not. Most respondents (70.7%) performed anxiolytic intervention guided by informally standardized hospital protocol. In clinical practice, 90% of respondents used pharmacological and/or non-pharmacological intervention to alleviate anxiety in children. Nearly half of the respondents (53.7%) used premedication to reduce anxiety, and midazolam was most frequently used. Parental presence during induction of anesthesia was considered the most effective non-pharmacological intervention (60.4%), and was allowed by 78% of respondents, and watching a video was considered the second most effective intervention (27.1%).
CONCLUSIONS
Korean pediatric anesthesiologists use both pharmacological and non-pharmacological interventions to alleviate preoperative anxiety, and these interventions are generally guided by an informally standardized hospital protocol. Anesthesiologists requiring effective anxiety reduction prefer pharmacological intervention and most commonly use intravenous midazolam, whereas those that want safe anxiety reduction prefer non-pharmacological intervention and most frequently use parental presence during induction of anesthesia.

Keyword

Anesthesia; Anxiety; Pediatrics; Policy; Premedication; Preoperative period

MeSH Terms

Anesthesia*
Anesthesia, General
Anxiety*
Child
Surveys and Questionnaires
Electronic Mail
Humans
Korea*
Midazolam
Parents
Pediatrics
Premedication
Preoperative Period
Midazolam

Reference

1. Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children. Anaesthesia. 1997; 52:970–6. DOI: 10.1111/j.1365-2044.1997.202-az0337.x. PMID: 9370839.

2. Kain ZN, Mayes LC, O’Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996; 150:1238–45. DOI: 10.1001/archpedi.1996.02170370016002.

3. Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S. Premedication in the United States: a status report. Anesth Analg. 1997; 84:427–32. DOI: 10.1213/00000539-199702000-00035. PMID: 9024042.

4. Mirakhur RK. Preanaesthetic medication: a survey of current usage. J R Soc Med. 1991; 84:481–3. PMID: 1886116. PMCID: PMC1293378.

5. Haas U, Motsch J, Schreckenberger R, Bardenheuer HJ, Martin E. Premedication and preoperative fasting in pediatric anesthesia. Results of a survey. Anaesthesist. 1998; 47:838–43. DOI: 10.1007/s001010050633. PMID: 9830555.

6. Nagahama H, Yagi K, Noda M, Hara K, Kikuchi S, Nagatsu M, et al. A survey of opioid use in preanesthetic medication. Masui. 1998; 47:1373–6. PMID: 9852705.

7. Payne K, Moore EW, Elliott RA, Moore JK, McHugh GA. Anaesthesia for day case surgery: a survey of paediatric clinical practice in the UK. Eur J Anaesthesiol. 2003; 20:325–30. DOI: 10.1017/S0265021503000504. PMID: 12703838.

8. Yip P, Middleton P, Cyna AM, Carlyle AV. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev. 2009; (3):CD006447. DOI: 10.1002/14651858.cd006447.pub2.

9. Kain ZN, Caldwell-Andrews AA, Krivutza DM, Weinberg ME, Wang SM, Gaal D. Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States 1995-2002: results of a follow-up national survey. Anesth Analg. 2004; 98:1252–9. DOI: 10.1213/01.ANE.0000111183.38618.D8. PMID: 15105196.

10. Esener Z, Ustun E. Epidemiology in pediatric anesthesia. A computerized survey of 10,000 anesthetics. Turk J Pediatr. 1994; 36:11–9. PMID: 8191604.

11. Rautakorpi P, Ali-Melkkila T, Kanto J. Anticholinergic drugs in paediatric anaesthesia. A survey of their present position in Finland 1990. Ann Chir Gynaecol. 1994; 83:64–8. PMID: 8053641.

12. Rautakorpi P, Manner T, Kanto J. A survey of current usage of anticholinergic drugs in paediatric anaesthesia in Finland. Acta Anaesthesiol Scand. 1999; 43:1057–9. DOI: 10.1034/j.1399-6576.1999.431015.x. PMID: 10593471.

13. Parnis SJ, van der Walt JH. A national survey of atropine use by Australian anaesthetists. Anaesth Intensive Care. 1994; 22:61–5. PMID: 8160950.

14. Wright KD, Finley GA, Lee DJ, Raazi M, Sharpe D. Practices of anesthesiologists to alleviate anxiety in children and adolescents in Canada. Can J Anaesth. 2013; 60:1161–2. DOI: 10.1007/s12630-013-0018-4. PMID: 24037746.

15. Roman DE, Barker I, Reilly CS. Anaesthetists’ attitudes to parental presence at induction of general anaesthesia in children. Anaesthesia. 1993; 48:338–40. DOI: 10.1111/j.1365-2044.1993.tb06959.x. PMID: 8494141.

16. Kain ZN, Ferris CA, Mayes LC, Rimar S. Parental presence during induction of anaesthesia: practice differences between the United States and Great Britain. Paediatr Anaesth. 1996; 6:187–93. DOI: 10.1111/j.1460-9592.1996.tb00426.x. PMID: 8732609.