Sola Chrystelle, Lefauconnier Audrey, Bringuier Sophie, Raux Olivier, Capdevila Xavier, Dadure Christophe
Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Paediatr Anaesth. 2017 Aug;27(8):827-834. doi: 10.1111/pan.13180. Epub 2017 Jun 16.
Preoperative anxiety management receives special attention in pediatric anesthesia. Different pharmacological and nonpharmacological techniques can be employed. This study was designed to assess three different strategies for childhood preoperative anxiolysis: midazolam premedication, midazolam in combination with portable Digital Video-Disk player, or video distraction strategy alone.
In this prospective randomized study, children aged 2-12 years were assigned to one of the three study groups. The primary outcome was a change in preoperative children's anxiety, from baseline (before transfer to the preanesthetic holding area) to separation from parents, assessed by the Modified Yale Preoperative Anxiety Scale (mYPAS) and the Visual Analog Anxiety Scale (VAS-Anxiety). Delirium emergence, postoperative pain, and parental satisfaction were also collected.
One hundred and thirty-five patients were enrolled. The three preventive strategies allowed control of preoperative distress. Within the three study groups, no significant change was objectified in the anxiety level from baseline to separation from parents (mean change in mYPAS midazolam group: 2.4 95% CI [-1.7 to 6.3]; midazolam+Digital Video-Disk group: -1.0 95% CI [-5.9 to 3]; and Digital Video-Disk group: 1.4 95% CI [-4 to 6.7]). Comparison of change in preoperative children's anxiety between the groups did not show any difference. Emergence delirium, postoperative pain scores, and analgesic consumption were similar between the groups and parents' satisfaction was excellent.
Both pharmacological premedication and video distraction are effective strategies for controlling preoperative childhood anxiety. The combination of midazolam and Digital Video-Disk player was not better than either alone.
术前焦虑管理在小儿麻醉中受到特别关注。可采用不同的药物和非药物技术。本研究旨在评估三种不同的儿童术前抗焦虑策略：咪达唑仑术前用药、咪达唑仑联合便携式数字视频光盘播放器或单纯视频分散注意力策略。
在这项前瞻性随机研究中，将2至12岁的儿童分配到三个研究组之一。主要结局是术前儿童焦虑的变化，从基线（转移至麻醉前等待区之前）到与父母分离，通过改良耶鲁术前焦虑量表（mYPAS）和视觉模拟焦虑量表（VAS-焦虑）进行评估。还收集了谵妄苏醒、术后疼痛和家长满意度。
共纳入135例患者。三种预防策略均能控制术前痛苦。在三个研究组中，从基线到与父母分离时焦虑水平无明显变化（咪达唑仑组mYPAS平均变化：2.4，95%置信区间[-1.7至6.3]；咪达唑仑+数字视频光盘组：-1.0，95%置信区间[-5.9至3]；数字视频光盘组：1.4，95%置信区间[-4至6.7]）。组间术前儿童焦虑变化的比较未显示任何差异。各组间谵妄苏醒、术后疼痛评分和镇痛药物消耗量相似，家长满意度良好。
药物术前用药和视频分散注意力都是控制儿童术前焦虑的有效策略。咪达唑仑与数字视频光盘播放器联合使用并不比单独使用任何一种更好。
