Paediatric preoperative teaching: effects at induction and postoperatively

Abstract

In a randomized controlled trial at Duke University and University of North Carolina Hospitals, 143 two to six year old children undergoing elective ambulatory surgery were randomized into a control group who received routine preoperative teaching or an intervention group who received an interactive teaching book. Changes in behaviour were measured by a Vernon behavioural questionnaire preoperatively and again two weeks postoperatively. A Global Mood Score was assessed in the preoperative holding area, at arrival into the operating room, and at the time of mask induction. The children in the control group were significantly more aggressive postoperatively than the intervention group (P < 0.05). Children who received the interactive teaching book exhibited higher levels of anxiety on the day of surgery, but fewer behavioural changes two weeks following surgery. Parents in the intervention group reported that preoperative teaching helped their child (87%) and themselves (83%).

Ansiedade, a criança e os pais

“…Contudo, esta redução se limitou ao período que antecedeu a cirurgia, não apresentando efeito ansiolítico durante a separação dos pais ou durante a indução da anestesia. Com relação aos pais, tais programas podem reduzir os níveis de ansiedade 43,44 . Estudo conduzido por Kain e col. 45 mostrou que 95% dos pais gostariam de ter informações relacionadas à anestesia da criança, incluindo possíveis complicações.…”

“…However, this decrease was limited to the period before surgery without anxiolytic effect during parents' separation or anesthetic induction. As to parents, such programs may decrease anxiety 43,44 . A study by Kain et al 45 has shown that 95% of parents would like to be informed about their child's anesthesia, including potential complications.…”

Perfil psicológico de crianças submetidas a adenoidectomia e/ou amigdalectomia no pré e pós-operatório

“…More than 40 years ago, Eckenhoff documented that pediatric psychological traumas may result from surgery and anesthesia. Six-month-old to six-year-old children are the most susceptible to presenting post-hospitalization behavioral disorders owing to their limited capacity to deal with abstract thinking 2,3 . Both surgeries in this study are considered elective surgeries, performed in a day hospital, that is, children come from the ambulatory, are operated on and discharged on the same day, except if there are complications.…”

“…Given that they are scheduled surgeries, there is a preoperative preparation. According to Margolis and Gimberg, ideally there should be a preoperative educational program containing a verbal description of the procedure together with the sensations to be experimented, associated with interactions between parents and children 3 . Directed to expanding the physician-patient relationship, we assessed the preparation provided to children and responsible people in the preoperative period, analyzing the psychological profile pre and postoperatively.…”

“…Directed to expanding the physician-patient relationship, we assessed the preparation provided to children and responsible people in the preoperative period, analyzing the psychological profile pre and postoperatively. If we perform the appropriate preoperative preparation, we will reduce the level of anxiety and the response to surgical stress, possibly reducing postoperative sequels 3 .…”