Bringuier Sophie, Dadure Christophe, Raux Olivier, Dubois Amandine, Picot Marie-Christine, Capdevila Xavier
Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Anesth Analg. 2009 Sep;109(3):737-44. doi: 10.1213/ane.0b013e3181af00e4.
Because children's anxiety influences pain perception, perioperative anxiety should be evaluated in clinical practice with a unique, useful, and valid tool to optimize pain management. In this study, we evaluated psychometric properties of the visual analog scale (VAS)-anxiety for children and to study its perioperative relevance in clinical practice.
One hundred children scheduled for elective surgery and general anesthesia were included. VAS-anxiety was measured at four timepoints and compared with both versions of State Spielbergers' questionnaires (State-Trait Anxiety Inventory for Youth [STAIY] and State-Trait Anxiety Inventory for Children [STAIC]) and the modified Yale Preoperative Anxiety Scale. Children's pain, parents' anxiety, and parents' proxy report of children's anxiety were evaluated using VAS.
The correlation between STAIC and VAS-anxiety was significant on the day of discharge. Moreover, changes over time were not significant with STAIC, whereas VAS-anxiety was significantly sensitive to changes over time in the two groups of age (7-11 yr and 12-16 yr). A receiver operating characteristic curve, using modified Yale Preoperative Anxiety Scale as reference, determined a VAS-anxiety cutoff at 30 to identify high-anxiety groups. Pain levels were significantly higher when children were anxious (VAS > or = 30) in the postoperative period. Moreover, children's anxiety and pain were higher when parents were anxious.
VAS-anxiety is a useful and valid tool to assess perioperative anxiety in children aged 7-16 yr. The influence of children's and parents' anxiety on children's postoperative pain suggests that VAS-anxiety should be recommended routinely for postoperative clinical practice to optimize anxiety and pain management.
由于儿童焦虑会影响疼痛感知，因此在临床实践中应使用一种独特、实用且有效的工具来评估围手术期焦虑，以优化疼痛管理。在本研究中，我们评估了儿童视觉模拟量表（VAS）-焦虑的心理测量特性，并研究其在临床实践中的围手术期相关性。
纳入100名计划接受择期手术和全身麻醉的儿童。在四个时间点测量VAS-焦虑，并与斯皮尔伯格状态问卷的两个版本（青少年状态-特质焦虑量表[STAIY]和儿童状态-特质焦虑量表[STAIC]）以及改良的耶鲁术前焦虑量表进行比较。使用VAS评估儿童疼痛、父母焦虑以及父母对儿童焦虑的代理报告。
出院当天STAIC与VAS-焦虑之间的相关性显著。此外，STAIC随时间的变化不显著，而VAS-焦虑对两组年龄（7-11岁和12-16岁）随时间的变化显著敏感。以改良的耶鲁术前焦虑量表为参考的受试者工作特征曲线确定VAS-焦虑临界值为30以识别高焦虑组。术后儿童焦虑时（VAS≥30）疼痛水平显著更高。此外，父母焦虑时儿童的焦虑和疼痛更高。
VAS-焦虑是评估7-16岁儿童围手术期焦虑的一种有用且有效的工具。儿童和父母焦虑对儿童术后疼痛的影响表明，应在术后临床实践中常规推荐使用VAS-焦虑来优化焦虑和疼痛管理。
