Preparing children for the operating room: psychological issues

Abstract

Childhood disease can be viewed in a psychosocial as well as a biologic context. Indeed, for many elective paediatric surgical procedures, the attendant psychological disruption appears to match or surpass the pathophysiological insult. Familiarity with developmental theories and psychological studies of hospitalization and anaesthesia in children can help one to recognize how different children cope with anxiety and respond to the stresses of hospital care. With this knowledge, the practitioner can prepare children for surgery more effectively and anticipate postoperative behavioural disturbances. This article reviews theories of personality development as well as psychological studies of hospitalization and anaesthesia in children. It then discusses parental presence during induction of anaesthesia and sedative premeditation. General issues regarding communication with children and their parents are discussed. Finally, specific strategies for preparing the environment, preparing the parents, and preparing the child for the operating room are discussed. Models of personality developmentPersonality can be defined as the organization of psychophysical systems within the individual that determine his or her unique adjustments to the environment, i Various features of personality theories can be used in attempting to understand how children of different ages respond to stress. With increased understanding of age-

Behavioural changes in children following day‐case surgery: a 4‐week follow‐up of 551 children

“…Waking up at night increased more often after anaesthetic induction with thiopentone, in 70/503 (14%) children, compared with 0/26 if propofol had been used (difference 14%, 95% CI 11-17), and after premedication with diazepam, in 44/274 (16%) compared with 20/219 (9%) if midazolam had been given (difference 7%, 95% CI 1-13). Waking up at night increased in 61/342 (18%) children who had been given opioids during anaesthesia compared with 14/209 (7%) of those who had no opioids (difference 11%, 95% CI 6-16), and in 33/127 (26%) of those who had postoperative opioids compared with 42/424 (10%) of the ones who had not been given opioids postoperatively (difference 16%, 95% CI [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] ................................................................................................................................................................................................................................................ …”

“…Once again, the importance of effective prevention and treatment of pain both in hospital and at home is emphasised. In all health care, whenever possible the child's age-dependent and individual phase of development should be taken into consideration [22] and unpleasant experiences should be avoided. Every contact with health care is equally important.…”

L’anxiété préopératoire : manifestations cliniques, évaluation et prévention

“…McGraw a proposé une interprétation développementale des facteurs psychologiques prédisposant à l'anxiété dans un contexte chirurgical [23]. Selon lui, le nouveau-né pourrait dans la majorité des cas être rassuré par l'équipe soignante, et ne ressentirait généralement pas difficilement la séparation avec les parents.…”

Ansiedade, a criança e os pais

“…Querem estar envolvidos nas decisões e são capazes de comunicar seu medo, como "acordar durante a cirurgia" ou "não acordar". Os adolescentes são mais independentes, necessitam privacidade, informação e temem perder o controle da situação 6,19 . Estudos acerca do efeito da idade sobre a ansiedade durante a indução da anestesia têm apresentado resultados conflitantes.…”

“…They want to be involved with decisions and are able to express their fears, such as "awakening during surgery" or "not awakening". Adolescents are more independent, need privacy, information and they have shown their fear of loosing control of the situation 6,19 . Studies on the effects of age on anxiety during anesthetic induction have shown conflicting results.…”