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Predictors of Pre-operative Anxiety in Indian Children

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Abstract

Objective

To identify the predictors of pre-operative anxiety in school-going children in India.

Methods

A prospective observational study was done at a tertiary care teaching hospital. Children aged 7–12 y scheduled for elective surgery and their parents were enrolled. Pre-operative anxiety in children and parents was assessed using STAI-C and STAI-P questionnaires respectively. The child’s anxiety in pre-op room, at the time of parental separation and induction of anesthesia were assessed using m-YPAS scale. Possible predictors of anxiety under ‘individual’, ‘social’ and ‘healthcare’ domains were analyzed using logistic regression. The quality of mask induction of anesthesia was assessed using Induction Compliance Checklist.

Results

Sixty children completed the study successfully. Receiver operating characteristic (ROC) curve indicted mYPAS score ≥ 30 (observed score) to identify children with high anxiety as identified by STAI-C ≥37 (self-reported score). The incidence of high anxiety escalated from pre-operative time (48%) to the time of parental separation (72%) and increased further at anesthetic induction (95%). Parental anxiety (p = 0.03) and socioeconomic background (p = 0.03) were significant predictors of the child’s pre-operative anxiety. The presence of >4 people at induction (p = 0.002), but not pre-operative anxiety, was found significantly more in children with poor quality of mask induction.

Conclusions

The incidence of peri-operative anxiety in Indian children is significant. Parental anxiety and socioeconomic background were found significant predictors of high pre-operative anxiety in our set-up.

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References

  1. Corman H, Hornick E, Kritchman M, Terestman N. Emotional reaction of surgical patients to hospitalization, anesthesia and surgery. Am J Surg. 1958;96:646–53.

    Article  PubMed  CAS  Google Scholar 

  2. Vernon DT, Foley JM, Sipowiwcz R, Shutman J. The psychological responses of children to hospitalization and illness. Springfield: Thomas Books; 1965. p. 1–5.

    Google Scholar 

  3. Melamed BG, Siegel LG. Reduction of anxiety in children facing hospitalization and surgery by use of filmed modelling. J Consult Clin Psychol. 1975;43:511–21.

    Article  PubMed  CAS  Google Scholar 

  4. Golden L, Pagala M, Sukhavasi S, Nagpal D, Ahmad A, Mahanta A. Giving toys to children reduces their anxiety about receiving premedication for surgery. Anesth Analg. 2006;102:1070–2.

    Article  PubMed  Google Scholar 

  5. Lee J, Lee J, Lim H, et al. Cartoon distraction alleviates anxiety in children during induction of anesthesia. Anesth Analg. 2012;115:1168–73.

    Article  PubMed  CAS  Google Scholar 

  6. Bodas J, Ollendick TH. Test anxiety: a cross-cultural perspective. Clin Child Fam Psychol Rev. 2005;8:65–88.

    Article  PubMed  Google Scholar 

  7. Samaan RA. The influences of race, ethinicity, and poverty on the mental health of children. J Health Care Poor Underserved. 2000;11:100–10.

    Article  PubMed  CAS  Google Scholar 

  8. Spielberger CD, Gorsuch RL, Lushene RE, Vagg PR, Jacobs GA. Manual for state-trait anxiety inventory. California, USA: Consulting Psychologists press; 1983.

    Google Scholar 

  9. Kain ZN, Mayes LC, Cicchetti DV. Measurement tool for pre-operative anxiety in young children: the Yale pre-operative anxiety scale. Child Neuropsychol. 1995;1:203–10.

    Article  Google Scholar 

  10. Keith RM. A frequent factor in the origins of primary nocturnal enuresis: anxiety in third year of life. Dev Med Child Neurol. 1968;10:465–70.

    Article  Google Scholar 

  11. Malhotra S, Randhawa A. A schedule for measuring temperament in children. Preliminary data on development and standardization. Indian J Clin Psychol. 1982;9:203–10.

    Google Scholar 

  12. Aggarwal OP, Bhasin SK, Sharma AK, Chhabra P, Aggarwal K, Rajaura OP. A new instrument (scale) for measuring the socioeconomic status of a family: priliminary study. Indian J Comm Med. 2005;30:111–4.

    Article  Google Scholar 

  13. Lerman J, Sampathi V, Watt S. Induction, maintenance and emergence from anesthesia. In: Gregory GA, Andropoulas DB, editors. Gregory’s Pediatric Anesthesia. 5th ed. West Sussex: Blackwell Publishing Ltd; 2012. p. 330–60.

  14. Kain ZN, Mayes L, O'Connor T, Cicchetti DV. Pre-operative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996;150:1238–45.

    Article  PubMed  CAS  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Davidson AJ, Shrivastava PP, Jamsen K, Haung GH, Czarnecki C, Gibson MA. Risk factors for anxiety at induction of anesthesia: a prospective cohort study. Pediatr Anaesth. 2006;16:919–27.

    Article  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Wollin SR, Plummer JL, Owen H, Hawkins RM, Materazzo F. Predictors of preoperative anxiety in children. Anesth Intensive Care. 2003;31:69–74.

    CAS  Google Scholar 

  19. The World Bank-Country and lending groups [Internet]. 2016[cited 2016 Mar 27]. Available at: http://data.worldbank.org/about/country-and-lending-groups#Lower_middle_income.

  20. Jain A, Runa P. Social sector and economic reforms (with special reference to public health). Int Res J Social Sci. 2014;3:38–42.

    Google Scholar 

  21. Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstadter MB. The Yale pre-operative anxiety scale: how does it compare with a “gold standard”? Anesth Analg. 1997;85:783–8.

    Article  PubMed  CAS  Google Scholar 

  22. Fourtier MA, Del Rosario AM, Martin SR, Kain ZN. Peri-operative anxiety in children. Pediatr Anaesth. 2010;20:318–22.

    Article  Google Scholar 

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Contributions

RM: Data acquisition, analysis, drafting of the manuscript; SY and NBP: Data interpretation and critical revision of the manuscript; AK: Data analysis, interpretation and critical revision of manuscript; PJM: Concept and design of the study, data analysis and interpretation, manuscript preparation and critical revision; will act as guarantor for this paper.

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Correspondence to Preethy J Mathew.

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Malik, R., Yaddanpudi, S., Panda, N.B. et al. Predictors of Pre-operative Anxiety in Indian Children. Indian J Pediatr 85, 504–509 (2018). https://doi.org/10.1007/s12098-018-2606-3

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  • DOI: https://doi.org/10.1007/s12098-018-2606-3

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