Ansiedade, a criança e os pais

Eduardo Toshiyuki Moro; Norma Sueli Pinheiro Módolo

doi:10.1590/S0034-70942004000500015

Review Article

Ansiedade, a criança e os pais

Children, parents and anxiety

Eduardo Toshiyuki Moro; Norma Sueli Pinheiro Módolo

http://dx.doi.org/10.1590/S0034-70942004000500015 Braz J Anesthesiol, vol.54, n5, p.728-738, 2004

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Resumo

JUSTIFICATIVA E OBJETIVOS: A ansiedade pré-operatória na criança é caracterizada por tensão, apreensão, nervosismo e preocupação e pode ser expressa de diversas formas. Alterações de comportamento no pós-operatório como enurese noturna, distúrbios alimentares, apatia, insônia, pesadelos e sono agitado podem ser resultado desta ansiedade. Em algumas crianças, estas alterações persistem por até um ano. O objetivo deste trabalho é avaliar os aspectos envolvidos com a ansiedade que afeta a criança e os pais durante o período que antecede a cirurgia, bem como as intervenções, farmacológicas ou não, para reduzi-la. CONTEÚDO: O artigo aborda a ligação entre a ansiedade pré-operatória em crianças e as alterações de comportamento que podem ocorrer no período pós-operatório, bem como a influência de variáveis como idade, temperamento, experiência hospitalar prévia e dor. Medidas para reduzir a ansiedade pré-operatória na criança como a presença dos pais durante a indução da anestesia ou programas de informação e a utilização de medicação pré-anestésica também são revisadas. CONCLUSÕES: O período que antecede a cirurgia acompanha-se de grande carga emocional para toda família, sobretudo para a criança. Um pré-operatório turbulento significa, para muitas crianças, alterações de comportamento que se manifestam de forma variada e por períodos prolongados em algumas vezes. A presença dos pais durante a indução da anestesia e programas de preparação pré-operatórios para a criança e para os pais podem ser úteis para casos selecionados, levando em conta a idade, temperamento e experiência hospitalar prévia. A medicação pré-anestésica com benzodiazepínicos, em especial o midazolam, é claramente o método mais eficaz para redução da ansiedade pré-operatória em crianças e das alterações de comportamento por ela induzidas.

Palavras-chave

ANESTESIA, AVALIAÇÃO PRÉ-OPERATÓRIA, MEDICAÇÃO PRÉ-ANESTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: Preoperative pediatric anxiety is characterized by stress, worry, nervosism and concern and may be expressed in different ways. Postoperative behavior changes, such as nocturnal enuresis, dietary problems, apathy, insomnia, nightmares and agitated sleep may be results of this anxiety. In some children, these changes persist for one year. This study aimed at evaluating anxiety-related aspects affecting children and parents in the preoperative period, as well as pharmacological or non-pharmacological interventions to minimize them. CONTENTS: The relationship between preoperative anxiety in children and postoperative behavior changes, as well as the influence of variables such as age, temperament, previous hospital experience and pain are discussed. Approaches to decrease childrens preoperative anxiety, such as the presence of parents during anesthetic induction or information programs and preanesthetic medication are reviewed. CONCLUSIONS: The preoperative period is accompanied of an emotional overload for the whole family, especially the child. For many children, a turbulent preoperative period may translate into several behavior changes lasting for long periods of time. The presence of parents during anesthetic induction and the preoperative preparation of children and parents may be useful for selected cases, taking into account age, temperament and previous hospital experience. Preanesthetic medication with benzodiazepines, especially midazolam, is clearly the most effective method to decrease postoperative anxiety in children and their related behavior changes.

Keywords

ANESTHESIA, PRE-ANESTHETIC MEDICATION, PREOPERATIVE EVALUATION

Referencias

Caumo W, Broenstrub JC, Fialho L. Risk factors for post- operative anxiety in children. Acta Anaesthesiol Scand. 2000;44:782-789.

Kain ZN, Mayes LC, Wang SM. Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective?. Anesthesiology. 1998;89:1147-1156.

Kain ZN, Mayes LC. Anxiety in Children during the Perioperative Period. Child Development and Behavioral Pediatrics, Mahwah. 1996:85-103.

Rice LJ, Cravero J. Pediatric Anesthesia. Clinical Anesthesia. 1996;44:1115-1124.

Lamb M, Hwang C, Frodi A. Security of mother and father infant attachment and its relation to sociability with strangers in traditional and nontraditional Swedish families. Infant Behavior and Development. 1982;5:355-367.

Steward DJ. Preoperative Evaluation and Preparation for Surgery. Pediatric Anesthesia. 2002:175-190.

Watson AT, Visram A. Children`s preoperative anxiety and postoperative behaviour. Paediatr Anaesth. 2003;13:188-204.

Kain ZN, Wang SM, Mayes LC. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg. 1999;88:1042-1047.

Schwartz BH, Albino JE, Tedesco LA. Effects of psychological preparation on children hospitalized for dental operations. J Pediatr. 1983;102:634-638.

Meyers E, Muravchick S. Anesthesia induction technics in pediatric patients: a controlled study of behavioral consequences. Anesth Analg. 1977;56:538-542.

Eckenhoff JE. Relationship of anesthesia to postoperative personality changes in children. Am J Dis Child. 1958;86:587-591.

Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children. Anaesthesia. 1997;52:970-976.

Kain ZN, Mayes LC, O`Connor TZ. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996;150:1238-1245.

Vessey JE, Bogetz MS, Dunleavey MF. Memories of being anesthetized as a child. Anesthesiology. 1994;81:A1384.

Ader R, Cohen N, Felten D. Psychoneuroimmunology: interactions between the nervous system and the immune system. Lancet. 1995;345:99-103.

Chrousos G, Gold P. The concepts of stress and stress system disorders: Overview of physical and behavioral homeostasis. JAMA. 1992;267:1244-1252.

Chernow B, Alexander HR, Smallridge RC. Hormonal responses to graded surgical stress. Arch Intern Med. 1987;147:1273-1278.

Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990;73:308-327.

McGraw T. Preparing children for the operating room: psychological issues. Can J Anaesth. 1994;41:1094-1103.

Bevan JC, Johnston C, Haig MJ. Preoperative parental anxiety predicts behavioural and emotional responses to induction of anaesthesia in children. Can J Anaesth. 1990;37:177-182.

Vetter TR. The epidemiology and selective identification of children at risk for preoperative anxiety reactions. Anesth Analg. 1993;77:96-99.

Holm-Knudsen RJ, Carlin JB, McKenzie IM. Distress at induction of anaesthesia in children: A survey of incidence associated factors and recovery characteristics. Paed Anaesth. 1998;8:383-392.

Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes following routine ENT operations in two-to-tem-year-old children. Paed Anaesth. 1996;6:45-49.

Kain ZN, Mayes LC, Caramico LA. Social adaptability and other personality characteristics as predictors for children`s reactions to surgery. J Clin Anesth. 2001;12:549-553.

Lumley MA, Melamed BG, Abeles LA. Predicting children`s presurgical anxiety and subsequent behavior changes. J Pediatr Psychol. 1993;18:481-497.

Provence S, Mayes L. Separation and Deprivation. Child and Adolescent Psychiatry: A Comprehensive Textbook. 1996:382-394.

McCann ME, Kain ZN. The management of preoperative anxiety in children: an update. Anesth Analg. 2001;93:98-105.

Shirley PJ, Thompson N, Kenward M. Parental anxiety before elective surgery in children: A British perspective. Anaesthesia. 1998;53:956-959.

Ryder IG, Spargo PM. Parents in anaesthetic room: A questionnaire survey of parents` reactions. Anaesthesia. 1991;46:977-979.

Vessey JA, Bogetz MS, Caserza CL. Parental upset associated with participation in induction of anaesthesia in children. Can J Anaesth. 1994;41:276-280.

Litman RS, Berger AA, Chhibber A. An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery. Paediatr Anaesth. 1996;6:443-447.

Gil KM, Ginsberg B, Muir M. Patient-controlled analgesia in postoperative pain: the relation of psychological factors to pain and analgesic use. Clin J Pain. 1990;6:137-142.

LeBaron S, Zelter L. Assessment of acute pain and anxiety in children and adolescents by self-reports, observer reports, and a behavior checklist. J Consult Clin Psychol. 1984;52:729-738.

Jamison RN, Taft K, O`Hara JP. Psychosocial and pharmacologic predictors of satisfaction with intravenous patient-controlled analgesia. Anesth Analg. 1993;77:121-125.

Thomas V, Heath M, Rose D. Psychological characteristics and the effectiveness of patient-controlled analgesia. Br J Anaesth. 1995;74:271-276.

Kain ZN, Ferris CA, Mayes LC. Parental presence during induction of anaesthesia: practice differences between the United States and Great Britain. Paediatr Anaesth. 1996;6:187-193.

Hannallah RS, Rosales JK. Experience with parents` presence during anaesthesia induction in children. Can Anaesth Soc J. 1983;30:286-289.

Kain ZN, Mayes L, Wang S. Parental presence and a sedative premedicant for children undergoing surgery: a hierarchical study. Anesthesiology. 2000;92:939-946.

Kain Z. Postoperative maladaptive behavioral changes in children: incidence, risks factors and interventions. Acta Anaesthesiol Belg. 2000;51:217-226.

Kain ZN, Mayes LC, Caramico LA. Parental presence during induction of anesthesia. A randomized controlled trial. Anesthesiology. 1996;84:1060-1067.

Kain ZN, Mayes LC, Caramico LA. Preoperative preparation in children: a cross-sectional study. J Clin Anesth. 1996;8:508-514.

Kain ZN, Caramico LA, Mayes LC. Preoperative preparation programs in children: a comparative examination. Anesth Analg. 1998;87:1249-1255.

Margolis JO, Ginsberg B, Dear GL. Paediatric preoperative teaching: effects at induction and postoperatively. Paediatr Anaesth. 1998;8:17-23.

Cassady JF, Wysocki TT, Miller KM. Use of a preanesthetic video for facilitation of parental education and anxiolysis before pediatric ambulatory surgery. Anesth Analg. 1999;88:246-250.

Kain ZN, Wang SM, Caramico LA. Parental desire for perioperative information and informed consent: a two-phase study. Anesth Analg. 1997;84:299-306.

Kain ZN, Mayes LC, Wang SM. Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology. 1999;90:758-765.

McCluskey A, Meakin GH. Oral administration of midazolam as a premedicant for a paediatric day-case anaesthesia. Anaesthesia. 1994;49:782-785.

Kain ZN, Mayes LC, Bell C. Premedication in United States: a status report. Anesth Analg. 1997;84:427-432.

Suresh S, Cohen IJ, Matuszczack M. Dose ranging, safety, and efficacy of a new oral midazolam syrup in children. Anesthesiology. 1998;89:A1313.

Kain ZN, Hofstadter MB, Mayes LC. Midazolam: effects on amnesia and anxiety in children. Anesthesiology. 2000;93:676-684.

Levine MF, Spahr-Schopfer IA, Hartley E. Oral midazolam premedication in children: the minimaum time interval for separation from parents. Can J Anaesth. 1993;40:726-729.

Lewyn MJ. Should parents be present while their children receive anesthesia?. Anesth Malpract Protect. 1993:56-57.

McGraw T, Kendrick A. Oral midazolam premedication and postoperative behaviour in children. Paediatr Anaesth. 1998;8:117-121.

Viitanen H, Annila P, Viitanen M. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg. 1999;89:75-79.

Viitanen H, Annila P, Viitanen M. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1-3 yr. Can J Anaesth. 1999;46:766-771.

Lapin SL, Auden SM, Goldsmith LJ. Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane. Paediatr Anaesth. 1999;9:299-304.

Davis PJ, Tome JA, McGowan Jr FX. Preanesthetic medication with intranasal midazolam for brief pediatric surgical procedures. Effect on recovery and hospital discharge times. Anesthesiology. 1995;82:2-5.

Gillerman RG, Hinkle AJ, Green HM. Parental presence plus oral midazolam decreases frequency of 5% halothane inductions in children. J Clin Anesth. 1996;8:480-485.

Griffith N, Howell S, Mason DG. Intranasal midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intra-observer variability. Br J Anaesth. 1998;81:865-869.

Ljungman G, Kreuger A, Andreasson S. Midazolam nasal spray reduces procedural anxiety in children. Pediatrics. 2000;105:73-78.

Karl HW, Rosenberger JL, Larach MG. Transmucosal administration of midazolam for premedication of pediatric patients. Comparison of the nasal and sublingual routes. Anesthesiology. 1993;78:885-891.

Diaz JH. Intranasal ketamine preinduction of paediatric outpatients. Paediatr Anaesth. 1997;7:273-278.

Cioaca R, Canavea I. Oral transmucosal ketamine: an effective premedication in children. Paediatr Anaesth. 1996;6:361-365.

Sekerci C, Donmez A, Ates Y. Oral ketamine premedication in children (placebo controlled doble-blind study). Eur J Anaesthesiol. 1996;13:606-611.

Funk W, Jacob W, Riedl T. Oral preanaesthetic medication for children: double-blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone. Br J Anaesth. 2000;84:335-340.

Sherwin TS, Green SM, Khan A. Does adjunctive midazolam reduce agitation after ketamine sedation for pediatric procedures?: A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000;3:229-238.

Filatov SM, Baer GA, Rorarius MG. Efficacy and safety of premedication with oral ketamine for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA. Acta Anaesthesiol Scand. 2000;44:118-124.

Nishina K, Mikawa K, Shiga M. Clonidine in paediatric anaesthesia. Paediatr Anaesth. 1999;9:187-202.

Nishina K, Mikawa K, Maekawa N. The efficacy of clonidine for reducing perioperative haemodynamic changes and volatile anaesthetic requirements in children. Acta Anaesthesiol Scand. 1996;40:746-751.

Mikawa K, Nishina K, Maekawa N. Oral clonidine premedication reduces postoperative pain in children. Anesth Analg. 1996;82:225-230.

Epstein RH, Mendel HG, Witkowski TA. The safety and efficacy of oral transmucosal fentanyl citrate for preoperative sedation in young children. Anesth Analg. 1996;83:1200-1205.

Friesen RH, Lockhart CH. Oral transmucosal fentanyl citrate for preanesthetic medication of pediatric day surgery patients with and without droperidol as a prophylactic anti-emetic. Anesthesiology. 1992;76:46-51.

Dsida RM, Wheeler M, Birmingham PK. Premedication of pediatric tonsillectomy patients with oral transmucosal fentanyl citrate. Anesth Analg. 1998;86:66-70.

Ginsberg B, Dear RB, Margolis JO. Oral transmucosal fentanyl citrate as an anaesthetic premedication when dosed to an opioid effect vs total opiod consumption. Paediatr Anaesth. 1998;8:413-418.

Ansiedade, a criança e os pais

Children, parents and anxiety

Eduardo Toshiyuki Moro; Norma Sueli Pinheiro Módolo

Resumo

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Abstract

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