This page is part of the 10N-Matrix for a high quality conduct of pediatric anesthesia care.
Fear: Unpleasant emotion caused by an actual or perceived threat, danger, pain, loss or harm.
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.
- 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
- parental anxiety and expectations
- Kain ZN et al. Preoperative psychological preparation of the child for surgery: an update. Anesthesiol Clin N Am 2005; 23: 597-614
- 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
- Rosenbaum A et al. The place of premedication in pediatric practice. Pediatr Anesth 2009; 19: 817-28
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- No Fear / No Awareness
- Normal Heart Rate
- No Postoperative Discomfort: