Anxiety level and risk factors among pediatric patients in endoscopic procedures outside the operating room: A cross-sectional study

Year 2020, , 693 - 697, 01.08.2020

Şule Arıcan , Aylin Yücel , Resul Yılmaz , Gülçin Hacıbeyoğlu , Merve Yusifov Sait Yüce Ahmet Topal

https://doi.org/10.28982/josam.775935

Abstract

Aim: Endoscopy under anesthesia creates stress and anxiety in children and their parents. In this study, we aimed to determine the preoperative anxiety levels of parents and patients who were routinely informed before endoscopy and examine the relationship between children and parents' state and trait anxiety levels.
Methods: A cross-sectional study was planned in which pediatric patients and parents were included. The study comprised 104 ASA I-II patients, aged 6-14 years, who were scheduled for endoscopy under deep sedation, and their parents. Immediately after the child patient was taken to the treatment room, parents were asked to fill out the State-Trait Anxiety Inventory. The demographic characteristics of the patients were recorded. The children’s anxiety level immediately after separation from parents was evaluated with Modified Yale Preoperative Anxiety Scale (m-YPAS). The patients were divided into two groups according to anxiety levels. Those with m-YPAS >30 were considered the anxiety (+) group, m-YPAS ≤30 were defined as the anxiety (-) group.
Results: The mean age of the patients was 11.8 (2.6) years (6-14). Twenty-nine patients had m-YPAS> 30, and 75 patients had m-YPAS ≤30. Parent anxiety levels were not significantly different between the two groups. There was a strong negative correlation (r=-0.589, P<0.001) between child’s anxiety and child age, a negative moderate correlation between child’s anxiety and parent age (r=-0.259, P=0.008), and weak positive correlation between child’s anxiety and complications (r=0.218, P=0.026). Young age was determined as an independent risk factor for increased child anxiety (OR: 0.501, P<0.001, 95% CI: 0.390-0.643).
Conclusion: There is no relationship between preoperative anxiety in school-age children and parental anxiety. Young age is an independent risk factor for the development of anxiety in the child.

Keywords

anxiety, m- YPAS, parent anxiety, STAI

Pediatrik hastalarda ameliyathane dışı endoskopik işlemlerde anksiyete seviyesi ve risk faktörleri: Kesitsel çalışma

Abstract

Amaç: Anestezi altında gerçekleştirilen endoskopi işlemi çocuklarda ve ebeveynlerinde stres ve kaygı yaratır. Bu çalışmada Endoskopi işlemi öncesi rutin bilgilendirilme yapılan ebeveynlerin ve hastaların preoperatif kaygı düzeylerini belirlemek ve çocuklar ile ebeveynlerin durum-sürekli kaygıları arasındaki ilişkiyi incelemeyi amaçladık.
Yöntemler: Çocuk hasta ve ebeveynlerin dahil edildiği kesitsel bir çalışma planlandı. Çalışmaya derin sedasyon altında endoskopi planlanan 6-14 yaş arası, ASA I-II, 104 çocuk hasta ve ebeveynleri dahil edildi. Çocuk hasta işlem odasına alındıktan hemen sonra ebeveynlerden Durum-Sürekli Kaygı Anketini doldurmaları istendi. Hastaların demografik özellikleri kayıt edildi. Çocukların kaygı seviyesi ebeveynlerinden ayrıldıktan hemen sonra Modifiye Yale Preoperatif Kaygı Skoru (m-YPAS) ile değerlendirildi. Hastalar anksiyete düzeylerine göre iki gruba ayrıldı. m-YPAS >30 anxiety (+) grup, m-YPAS ≤30 anxiety (-) grup olarak belirlendi.
Bulgular: Hastaların yaş ortalaması 11,8 (2,6) (6-14) yıldı. 29 hasta da m-YPAS >30, 75 hasta da m-YPAS ≤30’du. Ebeveyn kaygı seviyeleri iki grup arasında istatistiksel olarak anlamlı değildi. Çocuk kaygısı ile çocuk yaşı arasında negatif yönde kuvvetli (r=-0,589, P<0,001), ebeveyn yaşı arasında negatif yönde orta (r=-0,259, P=0,008), komplikasyon arasında pozitif yönde düşük (r=0,218, P=0,026) korelasyon vardı. Çocuk kaygı seviyesi için düşük çocuk yaşı bağımsız risk faktörü olarak belirlendi. (OR: 0,501, P<0,001, 95% CI: 0,390-0,643).
Sonuç: Okul çağı çocuklarda preoperatif kaygı ile ebeveyn kaygı arasında etkileşim yoktur. Küçük yaş, çocukta kaygı gelişimi için bağımsız risk faktörüdür.

Keywords

Kaygı, m-YPAS, Ebeveyn kaygı, STAI

References

• 1. Fredette ME, Lightdale JR. Endoscopic sedation in pediatric practice. Gastrointest Endosc Clin N Am. 2008;18:739-51.
• 2. Riddhiputra P, Ukarapol N. Effect of systematic psychological preparation using visual illustration prior to gastrointestinal endoscopy on the anxiety of both pediatric patients and parents. J Med Assoc Thai. 2006;89:231-5.
• 3. Hagiwara SI, Nakayama Y, Tagawa M, Arai K, Ishige T, Murakoshi T, et al. Pediatric Patient and Parental Anxiety and Impressions Related to Initial Gastrointestinal Endoscopy: A Japanese Multicenter Questionnaire Study. Scientifica (Cairo). 2015;2015:797564. doi: 10.1155/2015/797564.
• 4. Kain ZN, Mayes LC, O'Connor TZ, Cicchetti DV. Preoperative anxiety in children Predictors and outcomes. Arch Pediatr Adol Med. 1996;150:1238-45
• 5. Kain ZN, Mayes LC, Weisman SJ, Hofstadter MB. Social adaptability, cognitive abilities, and other predictors for children's reactions to surgery. J Clin Anesth. 2000;12:549-54.
• 6. Cui X, Zhu B, Zhao J, Huang Y, Luo A, Wei J. Parental state anxiety correlates with preoperative anxiety in Chinese preschool children. J Paediatr Child Health. 2016;52:649-55.
• 7. Karibe H, Aoyagi-Naka K, Koda A. Maternal anxiety and child fear during dental procedures: a preliminary study. J Dent Child. 2014;81:72-7.
• 8. Cagiran E, Sergin D, Deniz MN, Tanattı B, Emiroglu N, Alper I. Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children. J Int Med Res. 2014;42:572-80.
• 9. Spielberger CD, ed. Manual for the State-Trait Anxiety Inventory (STAI: FormY). Palo Alto, California: Consulting Psychologists Press,1983; 4–26.
• 10. Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstadter MB. The Yale Preoperative Anxiety Scale: how does it compare with a “gold standard”? Anesthesia & Analgesia. 1997;85:783-8.
• 11. Kim H, Jung SM, Yu H, Park SJ. Video distraction and parental presence for the management of preoperative anxiety and postoperative behavioral disturbance in children: a randomized controlled trial. Anesthesia & Analgesia. 2015;121:778-84.
• 12. Thung A, Tumin D, Uffman JC, Tobias JD, Buskirk T, Garrett W, et al. The Utility of the Modified Yale Preoperative Anxiety Scale for Predicting Success in Pediatric Patients Undergoing MRI Without the Use of Anesthesia. J Am Coll Radiol. 2018;15:1232-7.
• 13. Hatipoğlu Z, Kırdök O, Özcengiz D. Validity and reliability of the Turkish version of the modified Yale Preoperative Anxiety Scale Turk. J Med Sci. 2019;49:730-7.
• 14. Kain ZN, Caldwell-Andrews AA, Maranets I, Nelson W, Mayes LC. Predicting which child–parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach. Anesth Analg. 2006;102:81-4.
• 15. Caldwell-Andrews AA, Kain ZN, Mayes LC, Kerns RD, Ng D. Motivation and maternal presence during induction of anesthesia. Anesthesiology. 2005;103:478-83.
• 16. Drossman DA, Brandt LJ, Sears C, Li Z, Nat J, Bozymki EM. A preliminary study of patients’ concerns related to GI endoscopy. Am J Gastroenterol. 1996;91:287-91.
• 17. Fincher W, Shaw J, Ramelet AS. The effectiveness of a standardised preoperative preparation in reducing child and parent anxiety: A single-blind randomised controlled trial. J Clin Nurs. 2012;21:946-55.
• 18. Arai YC, Kandatsu N, Ito H, Sato Y, Satake Y, Mizutani M. Induction and emergence behavior of children undergoing general anesthesia correlates with maternal salivary amylase activity before the anesthesia. Acta Anaesthesiol. 2008;52:285-8.
• 19. McGraw T. Preparing children for the operating room: psychological issues. Can J Anaesth. 1994;41:1094-103.
• 20. Perrin EC, Ayoub CC, Willett JB. In the eyes of the beholder: family and maternal influences on perceptions of adjustment of children with a chronic illness. J Dev Behav Pediatr. 1993;14:94-105.
• 21. Litman RS, Berger AA, Chhibber A. An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery. Paediatr Anaesth 1996;6:443-7.
• 22. MacLaren JE, Thompson C, Weinberg Metal. Prediction of preoperative anxiety in children:who is most accurate? Anesth Analg. 2009;108:1777-82.
• 23. Varughese AM, Nick TG, Gunter J, Wang Y, Kurth CD. Factors predictive of poor behavioral compliance during inhaled induction in children. Anesth Analg. 2008;107:413
• 24. Hatava P, Olsson GL, Lagerkranser M. Preoperative psychological preparation for children undergoing ENT operations: a comparison of two methods. Paediatr Anaesth. 2000;10:477-86
• 25. Kleiber C, Craft-Rosenberg M, Harper DC. Parents as distraction coaches during i.v. insertion: a randomized study. J Pain Symptom Manage. 2001;22:851-61.
• 26. Ghazali DA, Faure JP, Breque C, Oriot D. Evaluation of stress patterns during simulated laparoscopy in residency. Minerva Chir. 2016;71:252-61.
• 27. Litke J, Pikulska A, Wegner T. Management of perioperative stress in children and parents. Part I the preoperative period. Anaesthesiol Intensive Ther. 2012;44:165-9.
• 28. Shevde K and Panagopoulos G. A survey of 800 patients’ knowledge, attitudes and concerns regarding anesthesia. Anesth Analg. 1991;73:190-8.
• 29. Power NM, Howard RF, Wade AM, Franck LS. Pain and behaviour changes in children following surgery. Arch Dis Child. 2012;97:879-84.