Hayhoe Simon, Pallett Scott, Zani Juliet, Trott Joanne
J Perianesth Nurs. 2018 Jun;33(3):312-318.e1. doi: 10.1016/j.jopan.2016.11.005. Epub 2017 Apr 5.
Preoperative anxiety in children is associated with postoperative distress in recovery. Both are predictors of long-term maladaptive behavior. Remedies have been suggested to modify individual risk factors, but overall strategy is lacking.
An approach to anxiety reduction coordinated throughout the hospital experience has been developed in our day-stay pediatric surgical unit.
There is a preadmission familiarization visit. On admission, time is spent in a playroom with other children. Anxiety is recorded using the modified Yale Preoperative Anxiety Scale. Children are distracted with an activity book during propofol induction. They are allowed to wake naturally, and emergence state is scored.
The incidence of emergence distress is low in our study. Of 68 children, only one exhibited emergence delirium and three had inconsolable crying.
Important elements in reducing emergence distress are preadmission visit, use of a playroom, effective analgesia, anesthetic maintenance without short-acting volatiles, and undisturbed recovery with a parent present for reassurance.
儿童术前焦虑与术后恢复过程中的痛苦相关。二者均为长期适应不良行为的预测因素。已有针对个体危险因素的改善措施，但缺乏整体策略。
我们日间小儿外科病房已制定一种在整个住院过程中协调进行的减轻焦虑的方法。
进行入院前的熟悉环境访视。入院时，患儿会在游戏室与其他儿童一起活动。使用改良的耶鲁术前焦虑量表记录焦虑情况。在丙泊酚诱导期间，让患儿通过一本活动手册分散注意力。允许患儿自然苏醒，并对苏醒状态进行评分。
在我们的研究中，苏醒期痛苦的发生率较低。68名儿童中，只有1名出现苏醒期谵妄，3名出现无法安抚的哭闹。
减轻苏醒期痛苦的重要因素包括入院前访视、使用游戏室、有效的镇痛、不使用短效挥发性药物维持麻醉以及在有家长陪伴安慰的情况下安静恢复。
