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No Fear (10Ns)

This page is part of the 10N-Matrix for a high quality conduct of pediatric anesthesia care.

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Definition

Fear: Unpleasant emotion caused by an actual or perceived threat, danger, pain, loss or harm.

Importance

Preoperative anxiety in children may result from the fear of pain, unfamiliar surroundings, a sense of loss of control, the presence of strangers, parental anxiety and many other perceived threats to their world. Some children will openly say they are frightened; others will cry, withdraw, cling to their parents or become agitated.

Consequences

  • anxiety may reduce cooperation; contribute to emergence delirium and increase pain and behavioral disturbances (sleep disturbances or nightmares, enuresis, separation anxiety and increased fear of doctors) after surgery
  • up to 50% of children will still have these disturbances two weeks after surgery and some several months
  • the incidence is increased after a stormy anesthetic induction and can be reduced if premedication or other strategies are used to reduce preoperative anxiety

Prevention and treatment

There are 3 strategies that can be used to reduce or moderate anxiety:

  • age-appropriate psychological preparation/ education (e.g. verbal or written information, video, mobile phone app or tablet-pc, hospital tours and role playing)
  • parental presence (can be stressful to some parents)
  • pharmacological premedication (benzodiazepines, α2-agonists, ketamine)

Special situations and challenges

  • the apprehensive child
  • the combative child
  • refusal
  • parental anxiety and expectations

Key references

  1. Kain ZN et al. Preoperative psychological preparation of the child for surgery: an update. Anesthesiol Clin N Am 2005; 23: 597-614
  2. Yip P et al. Non-pharmacological intervention for assisting induction of anaesthesia in children. Cochrane Database of Systematic Review 2009; Issue 3. Art. No. CD006447
  3. Rosenbaum A et al. The place of premedication in pediatric practice. Pediatr Anesth 2009; 19: 817-28 

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