Management of preoperative distress by anesthesia providers in toddlers and preschoolers

of a dissertation at the University of Miami. Dissertation supervised by Professor Rosina Cianelli. No. of pages in text. (246) The period of time associated with a child’s preparation for surgery and induction of general anesthesia is one of the most stressful events a child can experience. It is estimated that 40-60% of children experience preoperative anxiety before induction of anesthesia. Toddlers and preschoolers’ cognitive limitations, lack of self-control, high level of dependency on adults, and their limited understanding of the healthcare process make them prone to experience distress and excessive anxiety during the preoperative period. This inability to fully comprehend or manage the hospitalization experience leads to preoperative distress. Children’s preoperative distress has also been linked to ineffective coping mechanisms which are associated with significant negative behavioral, physiological, and clinical consequences. This study utilized a descriptive qualitative research approach to comprehensively determine the pharmacological and nonpharmacological interventions utilized by anesthesia providers in daily practice to reduce young children’s preoperative distress. Anesthesia providers’ choices and practices in the management of preoperative distress in children was explored using first hand descriptions and explanations. The participants in this study also provided descriptions which address the causes for preoperative distress in children and their recommendations to minimize its occurrence. A convenience sample of 20 participants were recruited for this study. Participants were anesthesiologists (n = 6), and certified registered nurse anesthetists (n = 14) who ranged in age from 33-59 years of age (M = 47.85, SD = 6.59) and worked an average of 42.95 hours (SD = 8.54) per week and spent a significant amount of their clinical time in pediatric anesthesia practice. Five major themes emerged from narratives provided during the anesthesia providers’ face-to-face interviews: (1) NonPharmacological Interventions Used by Anesthesia Providers, (2) Pharmacological Interventions Utilized by Anesthesia Providers, (3) Anesthesia Providers’ Perceptions of Preoperative Distress in Children, (4) Anesthesia Providers Best Practices and Recommendations, and (5) Anesthesia Providers’ Reactions to Parents and Children. The results of this study support the need to better prepare anesthesiologists and registered nurse anesthetists in the areas of child development and psychological management of children during the preoperative phase, provided clear evidence of best practices to manage preoperative distress in children, and suggest opportunities for changes in policy at the hospital level to increase the occurrence of positive health outcomes for patients, families and anesthesia providers. This study’s results suggest the importance of implementing a family centered approach to the preoperative management of children by including adequate preparation, and support to parents and children with health and socioeconomic disparities. Finally, this study provided evidence of the effects of operating room efficiency pressure on their ability to perform their clinical duties, and the lack of formal debriefing procedures to address negative clinical outcomes, and/or grief caused by their frequent interactions with chronic or terminally ill children.