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Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 651-658 (doi:10.1542/peds.2005-2920)
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ARTICLE

Preoperative Anxiety, Postoperative Pain, and Behavioral Recovery in Young Children Undergoing Surgery

Zeev N. Kain, MDa,b,c,d, Linda C. Mayes, MDa,c,d, Alison A. Caldwell-Andrews, PhDa,b, David E. Karas, MDa,c,e, Brenda C. McClain, MDa,b

a Center for the Advancement of Perioperative Health
b Anesthesiology
c Pediatrics
d Child Psychiatry
e Surgery, Yale University School of Medicine, New Haven, Connecticut

OBJECTIVE. Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children.

METHODS. We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy. Before surgery, we assessed child and parental situational anxiety and temperament. After surgery, all subjects were admitted to a research unit in which postoperative pain and analgesic consumption were assessed every 3 hours. After 24 hours in the hospital, children were discharged and followed up at home for the next 14 days. Pain management at home was standardized.

RESULTS. Parental assessment of pain in their child showed that anxious children experienced significantly more pain both during the hospital stay and over the first 3 days at home. During home recovery, anxious children also consumed, on average, significantly more codeine and acetaminophen compared with the children who were not anxious. Anxious children also had a higher incidence of emergence delirium compared with the children who were not anxious (9.7% vs 1.5%) and had a higher incidence of postoperative anxiety and sleep problems.

CONCLUSIONS. Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.

Key Words: anxiety • surgery • child behavior • pain • psychological impact

Abbreviations: T/A—tonsillectomy and adenoidectomy • PPMP—Postoperative Pain Measure for Parents • PHBQ—Post Hospitalization Behavioral Questionnaire • STAI—State Trait Anxiety Inventory • MBSS—Miller Behavioral Style Scale • mYPAS—modified Yale Preoperative Anxiety Scale • PACU—postanesthesia care unit • POD—postoperative day

Accepted Mar 20, 2006.


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