Anxiety of parents and children undergoing gastrointestinal endoscopy correlates with sedative doses

Year 2023, Volume: 6 Issue: 2, 238 - 243, 27.03.2023

Elif Erdoğan , Selda Tekin , Esra Polat , Esra Adıyeke , Nurten Bakan

https://doi.org/10.32322/jhsm.1214850

Abstract

Aim: Sedation is a fundamental component of the pediatric gastrointestinal endoscopy (GIE). The dosing of drugs to be used for sedating the child is an important aspect of the efficacy and safety of procedural sedation. Besides, outpatient procedures are stressful situations for pediatric patients and also their families, and therefore, parental anxiety may affect children indirectly. The first aim of the study was to assess the association between parental anxiety and required sedative dose in children undergoing GIE. The second aim was to assess the factors associated with children’s preoperative anxiety.
Material and Method: This study was a prospective, observational, and single-center study performed by the same fellowship-trained pediatric gastroenterology specialist and the same anesthesiology specialist. Parental anxiety was evaluated with the State-Trait-Anxiety-Scale (STAI) and children's anxiety was evaluated with the Modified Yale Preoperative Anxiety Scale (mYPAS). Midazolam, ketamine, propofol, and fentanyl were administered for the children’s sedation. There were 2 comparisons in this study, the anxiety of parents according to mean STAI scores, and anxiety of children according to mYPAS scores.
Results: Of 120 children and parents, 87 parents (73%) and 57 children (48%) had high anxiety. Of 120 parents, 111 parents (92%) were mothers of the children. Younger children had higher anxiety levels. Before and the start of the GIE heart rates of children were higher both in the high anxiety group of parents and children. In sedatives, high anxiety parents’ children and high anxiety children were required more ketamine dosages. (p<0,05)
Conclusion: Parental anxiety affects anxiety in children having GIE, and this increases the required sedative doses. Children’s younger age, lower weight and high ASA scores were associated with children’s preoperative anxiety.

Keywords

sedation, pediatrics, parent, endoscopy, preoperative anxiety

References

• Roelofse J, Jansen van Rensburg M, Gray R, Cherese L. SASA paediatric guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children: 2021–2026. South Afr J Anaesth Analg 2021; 27: S1-83. 

• CJ, Wilson S; American academy of pediatrics; american academy of pediatric dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics 2019; 143: e20191000.
• Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 2000; 106: 633–44.
• Aslam SL, Haque A, Jamil MT, Ariff M, Nasir S. Safety and efficacy of procedural sedation and analgesia in pediatric oncology patients. Cureus 2020; 12: e7442.
• Cagiran E, Sergin D, Deniz MN, Tanattı B, Emiroglu N, Alper I. Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children. J Int Med Res 2014; 42: 572–80.
• Messeri A, Caprilli S, Busoni P. Anaesthesia induction in children: a psychological evaluation of the efficiency of parents' presence. Paediatr Anaesth 2004; 14: 551.
• Ayenew NT, Endalew NS, Agegnehu AF, Bizuneh YB. Prevalence and factors associated with preoperative parental anxiety among parents of children undergoing anesthesia and surgery: A cross-sectional study. Int J Surg Open 2020; 24: 18–26.
• Getahun AB, Endalew NS, Mersha AT, Admass BA. Magnitude and factors associated with preoperative anxiety among pediatric patients: cross-sectional study. Pediatric Health Med Ther 2020; 11: 485–94.
• Cui X, Zhu B, Zhao J, Huang Y, Luo A, Wei J. Parental state anxiety correlates with preoperative anxiety in Chinese preschool children. J Paediatr Child Health 2016; 52: 649-55.
• Hatipoğlu Z, Kırdök O, Özcengiz D. Validity and reliability of the Turkish version of the modified Yale Preoperative Anxiety Scale. Turk J Med Sci 2019; 49: 730-737.
• Oner N, Le Compte A. Durumluk-Sürekli kaygı envanteri elkitabı, 20. Basım İstanbul: Boğaziçi. Üniversitesi Yayınları, 1985. s.3-5.
• Yang SM, Yi DY, Choi GJ, et al. Effects of Sedation Performed by an Anesthesiologist on Pediatric Endoscopy: a Single-Center Retrospective Study in Korea. J Korean Med Sci 2020; 35: e183.
• Jurair H, Bhimani A, Anwar-Ul-Haque. Outcome of pediatric procedural sedation & analgesia in a tertiary care hospital in Pakistan. Pak J Med Sci 2015; 31: 1554-7.
• Kannikeswaran N, Lieh-Lai M, Malian M, Wang B, Farooqi A, Roback MG. Optimal dosing of intravenous ketamine for procedural sedation in children in the ED-a randomized controlled trial. Am J Emerg Med 2016; 34: 1347-53.
• Min JY, Lee JR, Kang YS, Ho JH, Byon HJ. Pediatric characteristics and the dose of propofol for sedation during radiological examinations: a retrospective analysis. J Int Med Res 2021; 49: 300060521990992.
• Vargo J. Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America, E-Book: Elsevier Health Sciences; 2016.
• Green SM, Klooster M, Harris T, Lynch EL, Rothrock SG. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr 2001; 32: 26–33.
• Kaddu R, Bhattacharya D, Metriyakool K, Thomas R, Tolia V. Propofol compared with general 
anesthesia for pediatric GI endoscopy: is propofol better? Gastrointest Endosc 
2002; 55: 27–32.
• Li XR, Zhang WH, Williams JP, et al. A multicenter survey of perioperative anxiety in China: Pre- and postoperative associations. J Psychosom Res 2021 Aug; 147: 110528.
• Kallar SK, Jones GW. Postoperative complications. In: White PF, ed. Outpatient anesthesia. New York: Churchill Livingstone, 1990: 397– 415.
• Bumin Aydın G, Sakızcı Uyar B. Mothers Level of Education and Preoperative Informative Story Book Reading Helps Reduce Preoperative Anxiety in Children in Turkey. J Pediatr Nurs 2021; 60: e19-e23
• Dierckx B, Kok R, Tulen JH, Jaddoe VW, Hofman A, Verhulst FC. A prospective study of heart rate and externalising behaviours in young children. J Child Psychol Psychiatry 2014; 55: 402-10.
• MacLaren JE, Thompson C, Weinberg M, Fortier MA, Morrison DE, Perret D, et al. Prediction of preoperative anxiety in children: who is most accurate? Anesth Analg 2009; 108: 1777-82.
• Varughese AM, Nick TG, Gunter J, Wang Y, Kurth CD. Factors predictive of poor behavioral compliance during inhaled induction in children. Anesth Analg 2008; 107: 413-21.
• Chundamala J, Wright JG, Kemp SM. An evidence-based review of parental presence during anesthesia induction and parent/child anxiety. Can J Anaesth 2009; 56: 57-70.
• Facco E, Zanette G, Manani G. Italian version of Corah's Dental Anxiety Scale: normative data in patients undergoing oral surgery and relationship with the ASA physical status classification. Anesth Prog 2008; 55: 109-15.