Anxiety Before Surgery Complicates Recovery In Children

August 24, 2006

Children who are anxious before surgery experience a more painful,

slow, and complicated postoperative recovery, according to a Yale

School of Medicine study published this month in Pediatrics.

The study is important, said lead author, Zeev Kain, M.D., professor

in the Departments of Anesthesiology, Pediatrics, and the Yale Child

Study Center, because more than five million children in the United

States undergo surgery every year and up to 45 percent experience

significant stress and anxiety prior to surgery.

In his five-year study supported by the National Institutes of Health

(NIH), Kain and his team recruited 241 children aged five- to 12-

years-old who were scheduled to undergo elective tonsillectomy and

adenoidectomy. The personality characteristics of the children and

their parents were assessed before the surgery. All of the children

were admitted to a research unit at Yale following the surgery and

postoperative pain and analgesic consumption were recorded every

hour. After 24 hours in the hospital, the children were discharged

and followed up at home for the next 14 days.

The researchers found that anxious children experienced more problems

emerging from anesthesia and significantly more pain both during the

hospital stay and over the first three days at home. During home

recovery anxious children also consumed significantly more codeine

and acetaminophen and had a higher incidence of postoperative anxiety

and sleep problems.

" The results of our study indicate that decreasing the anxiety of

children before surgery will result in improved recovery after

surgery, reduced pain, and lower hospital costs, " Kain said. " But

ongoing randomized, controlled trials are needed to clearly draw this

conclusion. " Kain and his colleagues currently are examining this

issue in an NIH funded study.

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Kain is director of The Center for the Advancement of Perioperative

Health at Yale, which has $6 million in NIH grants. More details

about the center are available at www.perioperativehealth.org

Co-authors include Mayes, M.D., Karas, M.D., and

McClain, M.D.

Pediatrics 118: 651-658 (August 2006)

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