Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery
Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery
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DOI：
10.1542/peds.2005-2920
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发表时间：
2006-08-01
期刊：
影响因子：
8
通讯作者：
McClain, Brenda C.
中科院分区：
文献类型：
--
作者：
Kain, Zeev N.;Mayes, Linda C.;McClain, Brenda C.
OBJECTIVE.已发表的研究结果表明，术前焦虑水平较高的成年患者的术后恢复过程更痛苦、更缓慢、更复杂。到目前为止，还没有类似的调查进行了幼儿。我们招募了241名5至12岁的儿童，他们计划接受选择性门诊扁桃体切除术和腺样体切除术。手术前，我们评估了孩子和父母的情境焦虑和气质。手术后，所有受试者均入住研究单位，每3小时评估一次术后疼痛和镇痛药消耗。在医院呆了24小时后，孩子们出院了，并在接下来的14天里在家接受随访。在家中进行疼痛管理。父母对孩子疼痛的评估显示，焦虑的孩子在住院期间和在家的前3天都经历了更多的疼痛。在家庭康复期间，焦虑的儿童平均也消耗了比不焦虑的儿童更多的可待因和对乙酰氨基酚。焦虑患儿的苏醒期谵妄发生率也高于无焦虑患儿（9.7%比1.5%），术后焦虑和睡眠问题发生率也高于无焦虑患儿。接受手术的幼儿的术前焦虑与术后恢复更痛苦、睡眠和其他问题的发生率更高有关。
OBJECTIVE. Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children.METHODS. We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy. Before surgery, we assessed child and parental situational anxiety and temperament. After surgery, all subjects were admitted to a research unit in which postoperative pain and analgesic consumption were assessed every 3 hours. After 24 hours in the hospital, children were discharged and followed up at home for the next 14 days. Pain management at home was standardized.RESULTS. Parental assessment of pain in their child showed that anxious children experienced significantly more pain both during the hospital stay and over the first 3 days at home. During home recovery, anxious children also consumed, on average, significantly more codeine and acetaminophen compared with the children who were not anxious. Anxious children also had a higher incidence of emergence delirium compared with the children who were not anxious (9.7% vs 1.5%) and had a higher incidence of postoperative anxiety and sleep problems.CONCLUSIONS. Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.