Davidson Andrew J, Shrivastava Prani P, Jamsen Kris, Huang Grace H, Czarnecki Caroline, Gibson Margaret A, Stewart Stephanie A, Stargatt Robyn
Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Vic., Australia.
Paediatr Anaesth. 2006 Sep;16(9):919-27. doi: 10.1111/j.1460-9592.2006.01904.x.
In children anxiety at induction of anesthesia is a common and important aspect of the psychological impact of anesthesia and surgery. Previous studies examining risk factors for increased anxiety have found contradictory results. This may be due to using small, or highly selective population samples, or failure to adjust for confounding variables. Results may also be culturally or institutionally specific. The aim of this study was to identify possible risk factors in a large representative cohort of children.
One thousand two hundred fifty children aged 3-12 years were recruited. Anxiety at induction of anesthesia was assessed using the modified Yale preoperative anxiety scale. Children with an anxiety score of greater than 30 were classified as having high anxiety. Anesthetists were blinded to the assessment. Data recorded included age, gender, past healthcare history, family details, use of sedative premedication, anesthesia details, admission details, parental anxiety and child temperament. An unadjusted analysis was performed to identify possible risk factors for high anxiety. An adjusted regression analysis was then performed including the potential risk factors identified in the unadjusted analysis.
The incidence of high anxiety at induction was 50.2%. In the adjusted analysis, younger age, behavioral problems with previous healthcare attendances, longer duration of procedure, having more than five previous hospital admissions and anxious parents at induction were all associated with high anxiety at induction. Hospital admission via the day stay ward was associated with less anxiety. Sedative premedication was associated with less anxiety in children with ASA status greater than one. However, the variability explained by factors included in the model was low (5.3%).
Some simple preoperative questions can help identify children at risk of heightened anxiety at induction of anesthesia; however, it remains difficult to precisely predict which child will experience high anxiety.
在儿童中，麻醉诱导期的焦虑是麻醉和手术心理影响中常见且重要的一个方面。以往研究焦虑增加的风险因素时，结果相互矛盾。这可能是由于样本量小、样本高度选择性，或未对混杂变量进行调整。结果也可能具有文化或机构特异性。本研究的目的是在一个具有代表性的大型儿童队列中确定可能的风险因素。
招募了1250名3至12岁的儿童。使用改良的耶鲁术前焦虑量表评估麻醉诱导期的焦虑。焦虑评分大于30分的儿童被归类为高焦虑。麻醉医生对评估结果不知情。记录的数据包括年龄、性别、既往医疗史、家庭详情、镇静性术前用药情况、麻醉详情、入院详情、父母焦虑和儿童气质。进行了未调整分析以确定高焦虑的可能风险因素。然后进行了调整回归分析，纳入了未调整分析中确定的潜在风险因素。
诱导期高焦虑的发生率为50.2%。在调整分析中，年龄较小、既往就医时有行为问题、手术时间较长、既往住院次数超过五次以及诱导期父母焦虑均与诱导期高焦虑相关。通过日间病房入院与焦虑程度较低相关。对于美国麻醉医师协会（ASA）分级大于1级的儿童，镇静性术前用药与焦虑程度较低相关。然而，模型中纳入的因素所解释的变异性较低（5.3%）。
一些简单的术前问题有助于识别麻醉诱导期焦虑加剧风险的儿童；然而，精确预测哪个儿童会经历高焦虑仍然困难。
