Publication: Valoración de la ansiedad perioperatoria en niños sometidos a cirugía mayor ambulatoria
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2018-11-30
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Universidad Complutense de Madrid
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Abstract
La ansiedad perioperatoria es una experiencia común en la infancia, para la que no existe un abordaje unitario ni una suficiente concienciación por parte de la comunidad médico-científica. Su subjetividad, el desconocimiento sobre su cuantificación y la sobrecarga laboral contribuyen a que no se evalúe ni se considere adecuadamente, lo que puede desembocar en una importante tasa de complicaciones postoperatorias entre las que destacan, delirio al despertar, falta de recuperación postanestésica, aumento de la necesidad de analgesia, prolongación de la estancia media hospitalaria, el aumento de infecciones, los sobrecostes de gestión global y la sensación de una escasa calidad en la tarea médico-quirúrgica desempeñada; y a más largo plazo puede provocar ansiedad anticipatoria, pesadillas, etc.Existen diversas escalas para medir la ansiedad en niños en diferentes edades aunque fuera del contexto quirúrgico, como por ejemplo la Escala de Ansiedad Infantil de Spence (SCAS- P) para menores de 5 años y el cuestionario de autoevaluación de ansiedad estado-rasgo para niños mayores de 5 años (State-Trait Anxiety Inventory for Children: STAI-C). Sin embargo, la escala más frecuentemente utilizada para valorar la ansiedad pediátrica durante el proceso preoperatorio, la escala de ansiedad preoperatoria de Yale modificada (m-YPAS), está validada solo para niños de entre 2 y 12 años. Hasta la fecha, pocos son los estudios que comparan la utilidad de diferentes escalas de evaluación de ansiedad en el contexto perioperatorio, su relación entre sí y su capacidad en predecir si la inducción anestésica será óptima...
Perioperative anxiety is a common experience in childhood, for which there is neither a unitary approach nor sufficient awareness by health care providers in the clinical practice. Subjectivity, ignorance about its quantification and work overload contribute to the fact that it is frequently not evaluated or adequately considered. This can lead to a high rate of postoperative complications, among which are delirium on awakening, difficult postanesthetic recovery, an increased need for analgesia, prolongation of hospital stay, an increased rate of infections, increased costs of the process and the perception of poor quality of the task performed by the health-care team. Moreover, in the longer term negative perioperative experiences can lead to anticipatory anxiety, nightmares, etc. There are several scales to assess anxiety in children at different ages, although outside the surgical context (e.g. SCAPS for children under 5 and STAI-C for children over 5 years of age). The most frequently used scale for assessing pediatric anxiety during the preoperative process is m-YPAS (modified Yale scale), validated only in children aged 2 to 12 years. Previous studies demonstrate that anxiety in parents can negatively influence the anxiety of their children. To date, there are few studies comparing the utility of different anxiety assessment scales in the perioperative setting, correlation with each other and their ability to predict whether anesthetic induction will be optimal...
Perioperative anxiety is a common experience in childhood, for which there is neither a unitary approach nor sufficient awareness by health care providers in the clinical practice. Subjectivity, ignorance about its quantification and work overload contribute to the fact that it is frequently not evaluated or adequately considered. This can lead to a high rate of postoperative complications, among which are delirium on awakening, difficult postanesthetic recovery, an increased need for analgesia, prolongation of hospital stay, an increased rate of infections, increased costs of the process and the perception of poor quality of the task performed by the health-care team. Moreover, in the longer term negative perioperative experiences can lead to anticipatory anxiety, nightmares, etc. There are several scales to assess anxiety in children at different ages, although outside the surgical context (e.g. SCAPS for children under 5 and STAI-C for children over 5 years of age). The most frequently used scale for assessing pediatric anxiety during the preoperative process is m-YPAS (modified Yale scale), validated only in children aged 2 to 12 years. Previous studies demonstrate that anxiety in parents can negatively influence the anxiety of their children. To date, there are few studies comparing the utility of different anxiety assessment scales in the perioperative setting, correlation with each other and their ability to predict whether anesthetic induction will be optimal...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Pediatría, leída el 08-06-2017