Jain Shalini, Patel Suruchi, Arora Kishore Kumar, Sharma Aseem
Department of Anaesthesiology, MGM Medical College and MY Hospital, Indore, Madhya Pradesh, India.
Int J Appl Basic Med Res. 2023 Apr-Jun;13(2):101-105. doi: 10.4103/ijabmr.ijabmr_636_22. Epub 2023 Jul 17.
Preoperative anxiety is an important, yet often unattended problem in children. Minimizing anxiety and distress at the time of anesthetic induction may reduce adverse psychological and physiological outcomes. Sedative premedication and parental presence during anesthesia induction are among the most commonly employed strategies for reducing child anxiety.
The study aimed to compare the effectiveness of a pharmacological intervention (premedication with midazolam) versus behavioral intervention (parental presence) in reducing preoperative anxiety in children undergoing general anesthesia.
Sixty patients of age group of 4-12 years, of ASA Grade 1 and 2 and either sex posted for elective surgery under general anesthesia were divided into two groups of 30 each Group M (midazolam group) and Group P (parental presence). Group M received intravenous midazolam 0.03-0.05 mg/kg preoperatively and anxiety was measured in preoperative room, during separation from parents and during introduction of anesthesia mask, whereas in Group P, parents accompanied the child inside the operation theater and anxiety was measured at preoperative room and during introduction of mask. Parental anxiety was measured in both groups at preoperative room and waiting room. Modified Yale Preoperative Anxiety Scale (mYPAS) and State Trait Anxiety Inventory (STAI) tool was used to measure anxiety in children and parents, respectively.
The mean mYPAS score while the introduction of anesthesia mask in Group M was 31.30 ± 12.04 and in Group P was 63.19 ± 25.31, and the difference was found to be statistically significant ( = 0.001). In preoperative room, there was no significant difference in anxiety in the two study groups. The mean STAI score in Group P was 45.63 ± 1.45 and in Group M was 41.10 ± 1.69, and the difference was found to be statistically significant ( = 0.001). In preoperative room, parental anxiety was found to be comparable among the two groups. The mean duration of induction of anesthesia in Group M was 5.53 ± 1.01 min, and in Group P, it was 8.77 ± 2.03 min. The difference was found to be statistically significant ( = 0.001).
Both interventions were effective in reducing anxiety in children, but midazolam was more effective compared to parental presence. Parents in Group M were less anxious in the waiting room than Group P. Children in Group M were more compliant during the induction of anesthesia, hence a lesser duration of induction than Group P.
术前焦虑是儿童中一个重要但常被忽视的问题。在麻醉诱导时尽量减少焦虑和痛苦可能会减少不良的心理和生理后果。镇静性术前用药和麻醉诱导期间父母陪伴是最常用的减轻儿童焦虑的策略。
本研究旨在比较药物干预（咪达唑仑术前用药）与行为干预（父母陪伴）在减轻接受全身麻醉儿童术前焦虑方面的效果。
60例年龄在4至12岁、ASA分级为1级和2级、拟行全身麻醉下择期手术的患者，不分性别，被分为两组，每组30例。M组（咪达唑仑组）和P组（父母陪伴组）。M组术前静脉注射咪达唑仑0.03 - 0.05 mg/kg，在术前室、与父母分离时以及麻醉面罩置入时测量焦虑程度；而在P组，父母陪伴孩子进入手术室，在术前室和面罩置入时测量焦虑程度。在术前室和等候室测量两组父母的焦虑程度。分别使用改良耶鲁术前焦虑量表（mYPAS）和状态特质焦虑量表（STAI）工具测量儿童和父母的焦虑程度。
在M组麻醉面罩置入时，mYPAS平均得分是31.30 ± 12.04，P组为63.19 ± 25.31，差异有统计学意义（P = 0.001）。在术前室，两个研究组的焦虑程度无显著差异。P组STAI平均得分是45.63 ± 1.45，M组为41.10 ± 1.69，差异有统计学意义（P = 0.001）。在术前室，两组父母的焦虑程度相当。M组麻醉诱导的平均时长为5.53 ± 1.01分钟，P组为8.77 ± 2.03分钟。差异有统计学意义（P = 0.001）。
两种干预措施在减轻儿童焦虑方面均有效，但与父母陪伴相比，咪达唑仑更有效。M组的父母在等候室比P组的父母焦虑程度更低。M组的儿童在麻醉诱导期间更配合，因此诱导时间比P组短。
