Reduction of Postanesthetic Pediatric Distress: A Coordinated Approach.

PURPOSE: 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.

DESIGN: An approach to anxiety reduction coordinated throughout the hospital experience has been developed in our day-stay pediatric surgical unit.

METHODS: 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.

FINDING: The incidence of emergence distress is low in our study. Of 68 children, only one exhibited emergence delirium and three had inconsolable crying.

CONCLUSIONS: 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.