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Investigation of the effect of preoperative parental anxiety and sociodemographic characteristics on emergence agitation in patients undergoing pediatric adenotonsil surgery
Adenotonsillectomy, with or without adenoidectomy, is one of the most commonly performed surgical procedures worldwide in pediatric patients. Despite its widespread application, this surgery presents significant challenges for both surgeons and anesthesiologists due to the associated increased risks of morbidity and mortality. Safe administration of anesthesia is critical in avoiding complications and alleviating not only patient distress but also parental anxiety.
Preoperative anxiety in pediatric patients is influenced by several factors, including young age and parental concerns. Additionally, longer surgery durations (>30 minutes) and previous hospitalizations are known risk factors for heightened anxiety. Several previous studies have explored the relationship between parental stress levels and postoperative complications, including emergence agitation and pain. Research indicates a significant association between parental anxiety and postoperative behavioral disturbances in children.
The primary objective of this study is to evaluate the impact of preoperative parental anxiety and sociodemographic characteristics on the incidence and severity of emergence agitation in pediatric patients undergoing adenotonsillectomy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| observational | No intervention - cross sectional analysis |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| No intervention - observational study | Other | no group |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence and severity of emergence agitation | The incidence and severity of emergence agitation (EA) were evaluated in the postoperative recovery room using the Watcha Behavior Scale (WBS). The Watcha Behavior Scale is a four-point scale used to assess the severity of emergence agitation in pediatric patients after anesthesia: (1) calm and cooperative; (2) mild restlessness but easily consoled; (3) agitated and inconsolable; and (4) severely agitated, thrashing, or combative. | From 1 to 30 minutes after extubation |
| Measure | Description | Time Frame |
|---|---|---|
| Parental preoperative anxiety | Parental preoperative anxiety was assessed after study enrollment. For patients admitted one day before surgery, evaluation was conducted on the evening before; for those admitted on the day of surgery, it was performed in the preoperative waiting area. Anxiety levels were measured using the State-Trait Anxiety Inventory (STAI), which consists of two subscales: the State Anxiety Inventory (STAI-S) and the Trait Anxiety Inventory (STAI-T), each including 20 items. Each item is rated on a 4-point Likert scale, with total scores ranging from 20 to 80 for each subscale. Higher scores indicate higher levels of anxiety. |
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Inclusion Criteria:
Exclusion Criteria:
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Pediatric patients aged 3-7 years who underwent adenotonsil surgery in the ear, nose, throat (ENT) operating room of Ondokuz Mayıs University Hospital and their parents
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| Name | Affiliation | Role |
|---|---|---|
| Dilek Gemici, Specialist physician | Ondokuz Mayıs University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ondokuz Mayis University | Samsun | 55139 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15562048 | Result | Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, Feng R, Zhang H. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004 Dec;99(6):1648-1654. doi: 10.1213/01.ANE.0000136471.36680.97. | |
| 35544252 | Result | Ali AB, Khan F. Emergence Delirium and Its Association with Preoperative Anxiety in Paediatric Patients Undergoing Infra Umbilical Surgery Under Combined General and Caudal Anaesthesia: An Observational Study from a Tertiary Care Centre in a South Asian Country. Turk J Anaesthesiol Reanim. 2022 Apr;50(2):129-134. doi: 10.5152/TJAR.2021.1104. |
| Label | URL |
|---|---|
| The Association between Preoperative Parental Anxiety and Emergence Agitation in Preschoolers, 2017, Erkılıc, E. , Kesimci, E. , Doger, C. , Gumus, T. and Kanbak, O. , Open Journal of Epidemiology, 7, 18-26 | View source |
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| ID | Term |
|---|---|
| D000071257 | Emergence Delirium |
| ID | Term |
|---|---|
| D003693 | Delirium |
| D003221 | Confusion |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
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| during the preoperative day and the day of surgery |
| Preoperative anxiety in children | Children were accompanied by a parent until transfer to the operating room (OR). Preoperative anxiety levels were assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS) before separation from parents and prior to any intervention or drug administration. The m-YPAS is an observational scale with scores ranging from 23.33 to 100, with higher scores indicating greater anxiety. | During the day of surgery |
| Postoperative pain | Postoperative pain was assessed in the post-anesthesia care unit (PACU) using the Wong-Baker Faces Pain Rating Scale. This scale ranges from 0 to 10, with 0 indicating no pain and 10 indicating the worst pain. Higher scores indicate greater pain intensity. Pain scores were recorded at predefined time points during the early postoperative period. | During the first 30 minutes in the post-anesthesia care unit (PACU) |
| 38739185 | Result | Alves CS, Dias J, Azevedo S, Sousa F, Santos M, Lino J, Meireles L. Keep Calm: Does parental preoperative anxiety affect post-tonsillectomy pain scores in children? Eur Arch Otorhinolaryngol. 2024 Aug;281(8):4385-4392. doi: 10.1007/s00405-024-08683-0. Epub 2024 May 13. |
| 16882820 | Result | Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006 Aug;118(2):651-8. doi: 10.1542/peds.2005-2920. |
| 37996779 | Result | Yu H, Sun X, Li P, Deng X. Prevalence and risk factors of emergence agitation among pediatric patients undergo ophthalmic and ENT Surgery: a cross-sectional study. BMC Pediatr. 2023 Nov 24;23(1):598. doi: 10.1186/s12887-023-04434-y. |
| D009422 |
| Nervous System Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |