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Introducción: La presencia de los padres o de otros familiares ante la prestación de procedimientos dolorosos para el niño, así como en la reanimación pediátrica, ha provocado discusión entre profesionales de la salud, por las ventajas y desventajas que presenta. Objetivo: Teniendo en cuenta este problema, el objetivo de esta investigación consiste en identificar estudios científicos orientados a las ventajas de la presencia de los familiares en la sala de reanimación y/o en procedimientos dolorosos. Método: Fue realizada una revisión sistemática de la literatura con la siguiente pregunta de investigación: ¿Cuáles son las ventajas de la presencia de la familia en la sala de reanimación y/o procedimientos dolorosos? Resultados: Todos los artículos identifican ventajas de la presencia de la familia en la sala de reanimación y/o procedimientos dolorosos. Conclusiones: La investigación favorece el debate y la reflexión entre el equipo multidisciplinar sobre la presencia de los familiares de los niños frente a procedimientos dolorosos o reanimación. Sin embargo, a fin de que este proceso sea factible, es necesaria la formación y capacitación de todo el equipo de salud, para que puedan estar disponibles para explicar los procedimientos a los familiares y acompañarlos en todo el proceso (AU)

Introdução: A presença dos pais ou outros familiares perante a prestação de procedimentos dolorosos à criança bem como na reanimação pediátrica tem suscitado discussão aos profissionais de saúde, pelas vantagens e desvantagens que apresenta. Objetivo: Tendo em conta esta problemática, o objetivo desta investigação consiste em identificar estudos científicos orientados para vantagens da presença dos familiares na sala de reanimação e/ou em procedimentos dolorosos. Método: Foi elaborada uma revisão sistemática da literatura com a seguinte questão de investigação: Quais as vantagens da presença dos familiares na sala de reanimação e/ou em procedimentos dolorosos? Resultados: Todos os artigos identificam vantagens da presença dos familiares na sala de reanimação e/ou em procedimentos dolorosos. Conclusões: A pesquisa favorece o debate e a reflexão entre a equipa multidisciplinar sobre a presença dos familiares de crianças perante a realização de procedimentos dolorosos ou de reanimação. No entanto, para que este processo possa ser exequível, é necessário a formação e treino de toda a equipa de saúde, para que estes possam estar disponíveis para explicar os procedimentos aos familiares e acompanhá-los durante todo o processo (AU)

Introduction: The presence of parents or others relatives during the painful procedures to the child, as well as during the pediatric resuscitation has raised discussion among health professionals, both for its advantages and disadvantages. Objective: Considering this subject, the main goal of this investigation consists in identifying scientific studies that are oriented for the advantages of having family members at hand during resuscitation and/or painful procedures. Method: It was performed a systematic review of the literature with the following research question: What are the advantages of having family members in the resuscitation room and/or painful procedures? Results: All the articles identified advantages in having the presence of family members in the resuscitation room and/or during painful procedures. Conclusions: This research reinforces the debate and reflection among the multidisciplinary team about the presence of family members during the painful procedures or resuscitation performed to a child. However, in order for this process to be executable it is necessary to train all the health team, enabling them to explain the procedure to the family and accompany them throughout the process (AU)

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INTRODUCTION: With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during 'awake surgery', in particular of which aspects of the process may be distressing. METHODS: Seventy patients undergoing day case plastic surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients. RESULTS: Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as 'knife' and 'scalpel' provoke considerable anxiety in the conscious patient. This varied according to age and sex with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving. CONCLUSIONS: Technical jargon used by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.

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INTRODUCTION: It is well documented that music plays a role in reducing anxiety levels. Its role in reducing intra-operative anxiety levels in surgical patients while awake is less well known. We report the effects of music on intra-operative patient anxiety in both the elective and trauma plastic surgical setting. METHODS: Two groups of patients undergoing local anaesthetic surgical procedures were identified: those where music was played in the operating theatre (Group 1) and those where it was not (Group 2). Ninety-six patients were included. Subjectively anxiety was evaluated by the patient with a visual analogue scale (VAS) and objectively by the respiratory rate (RR), both pre and post-operatively. The unpaired t-test was used to evaluate the statistical significance of differences between the groups. RESULTS: The mean pre-operative VAS score was similar in both groups (5.7 in Group 1 and 5.8 in Group 2). The mean pre-operative RR was 15 breaths per minute in both groups. Post-operatively, the VAS score and RR were both lower in Group 1 (VAS: 3.5 vs 4.9; p<0.01 and RR: 11 vs 13 breaths per minute; p<0.05). CONCLUSIONS: In the era of the patient centred approach to clinical care, it is crucial to minimise patient anxiety. Music appears to reduce intra-operative anxiety in awake patients in both the elective and trauma plastic surgical setting. Easy listening music and chart classics appear to be suitable genres according to patients. We believe there is a role for a large, multicentre, randomised control study to examine the benefits of music in all local anaesthetic procedures across different specialties.

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Patients undergoing surgery are having high levels of anxiety and stress. Though not life threatening it adds an unnecessary financial burden to the hospital. We assessed the anxiolytic effects of oral propranolol 20 mg and 40 mg when given as premedication. This is a double blind, randomised, prospective clinical study involving 60 healthy patients (ASA I and II) undergoing minor elective surgery. Subjects in control group without any anxiolytic premedication (group I, n = 20) were compared with those receiving oral propranolol 20 mg (group II, n = 20) or 40 mg (group III, n = 20) with sips of water 2-hour prior to surgery. Anxiety level was assessed using 4-point anxiolysis score (1--tearful, 2--anxious but easily reassured, 3--calm, 4--asleep) in the holding area, after entering operating room, immediate postoperative and 2 hours after surgery. Fluctuation in pulse rate and BP was recorded. Statistical data was analysed using one-way ANOVA with posthoc test.Value of p < 0.05 was taken as significant. Twenty subjects in each group were required as calculated from reference study with difference of up to 30%, type I error of 0.5 and power of 80%. Anxiolysis score in operating room (group I--1.40 +/- 0.48, group II--1.95 +/- 0.58, group III--1.90 +/- 0.53) and immediate postoperative period (group I--1.25 +/- 0.43, group II--1.90 +0.53, group III--2.10 +/- 0.29) were significantly improved (p < 0.05) in groups II and III compared with control group. Variations in systolic BP and pulse rate were less in test groups (p < 0.05). No statistically significant difference was found after Intergroup comparison of test groups. Bradycardia (25%) and hypotension (10%) were more with 40 mg propranolol. Both 20 mg and 40 mg doses of propranolol are effective for pre-operative anxiolysis but 20 mg dose gives significant reduction in anxiety with minimal side-effects. Thus 20 mg propranolol premedication for reducing peri-operative anxiety and for cardiovascular stability is recommended.

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PURPOSE: The aim of the present study was to evaluate the levels of dental fear and anxiety in women with eating disorders (EDs) scheduled for oral surgery. PATIENTS AND METHODS: A total of 61 patients with EDs, an identical number of age-, gender-, and education-matched healthy controls, and 2 consecutive, randomly selected, clinical and nonclinical samples each consisting of 220 female subjects were included in the present study. The participants completed the demographic and clinical forms, as well as the modified dental anxiety scale (MDAS) and dental fear survey (DFS) before the surgical procedure. RESULTS: The mean scores of the MDAS and DFS for the study population correlated negatively with age and positively with a previous unpleasant experience related to dentistry (P < .01 for both). Patients with EDs had significantly greater mean scores on the MDAS than the clinical and nonclinical groups (P < .05 for both). Their mean scores on the DFS were significantly greater than those for the nonclinical participants (P < .05). A significant difference was found in the DFS subscale "fear of specific situations and stimuli" compared with the healthy matched controls and clinical and nonclinical subjects (P < .05 for all). CONCLUSION: The results of our study have shown that patients with EDs can be more sensitive to the auditory, visual, and contact stimuli of the oral surgery procedures under local anesthesia. They also had greater levels of dental fear and anxiety than routine clinical patients and randomly selected subjects from a nonclinical environment.

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La intervención de los payasos en el ámbito hospitalario es un programa para disminuir el malestar psicológico que conlleva la hospitalización infantil que se ha ido implantando en España y en otros países. El objetivo del estudio es evaluar el efecto de la intervención de los payasos de hospital sobre el malestar psicológico y las conductas desadaptativas de los niños y niñas que van a ser operados. La muestra la componen 61 niños y niñas de 3 a 12 años, sometidos a intervenciones programadas de cirugía menor, y que fueron asignados al grupo experimental y control. El malestar psicológico del niño/a se evaluó utilizando la escala FAS (Facial Affective Scale). Los comportamientos desadaptativos producidos después de la cirugía se registraron utilizando el PHBQ (Post Hospital Behavior Questionnaire). Nuestros resultados indican que los payasos de hospital no fueron eficaces para reducir el nivel de malestar psicológico. Las conductas desadaptativas de los niños y niñas en el grupo experimental disminuyeron después de la operación, aunque no alcanzaron la significación. Es necesario realizar más estudios que determinen los efectos de los payasos de hospital, teniendo en cuenta la edad, el sexo, la presencia de los padres y los diferentes contextos de hospitalización (AU)

The presence of clowns in health care settings is a program used in many countries to reduce distress in children who are undergoing surgery. The aim of the present study is to determine the effect of the presence of clowns on children’s distress and maladaptive behaviours while in hospital for minor surgery. The sample consisted of 61 pediatric patients (aged 3-12 years) undergoing general anesthesia for minor surgery. Participants were assigned to two groups: experimental and control group. The child’s distress was assessed using FAS (Facial Affective Scale). Postoperative maladaptive behaviors were evaluated one week after surgery, using the PHBQ (Post-Hospital Behavior Questionnaire). Our results suggest that clowns are not able to reduce the child’s level of distress. However, postoperative maladaptive behaviours in the experimental group decreased, but the decrease was not statistically significant. Further research is needed to determine the effects of clowns in hospitals, taking into account age, sex, parents’ presence, and diverse hospital settings (AU)

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We compared anxiety in mothers of children undergoing ambulatory surgery with female patients undergoing surgery themselves. We found that mothers were as anxious as patients undergoing major abdominal surgery and more anxious than patients undergoing minor surgery. Predictors of maternal anxiety were child age and maternal monitoring coping.

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INTRODUCTION: Waiting lists for surgical out-patients and elective operations are a major concern of the National Health Service. A Direct Access Minor Surgery programme in an ambulatory minor theatre area has been introduced to expedite patient treatment. The response of patients to this service has been assessed. PATIENTS AND METHODS: A postal questionnaire was offered to all patients attending for the Direct Access Minor Surgery over a period of 20 months (January 2002 to August 2003). Patients were asked about direct attendance for surgery without a prior out-patient appointment, about waiting time before operation on the day of surgery and the adequacy of pre-operative information. Overall satisfaction was assessed using a scoring system. The incidence of inappropriate referrals was analysed. The influence of the service on waiting lists and resources was assessed. RESULTS: A total of 221 patients were operated on, 257 lesions being excised. Response rate to the postal questionnaire was 55%. Of respondents, 75% thought that it was appropriate to attend the hospital directly without an out-patient clinic appointment. To 83% the waiting time was acceptable. Of patients, 90% were happy with the pre-operative information. Overall, 91% of respondents were very satisfied with the service. Inappropriate referrals were 4%. The new service reduced waiting time for minor surgery from 53 to 10 weeks. It also released approximately 140 new out-patient slots per annum. CONCLUSION: Direct Access Minor Surgery is a safe and favoured service with high patient satisfaction.

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PURPOSE: The purpose of this study was to produce a clinically useful, patient-derived, minor oral surgery outcome scale. PATIENTS AND METHODS: Seventy-seven consecutive patients scheduled for minor oral surgery were interviewed using semistructured interview techniques to identify those areas of life (domains) that patients believed will be affected by minor oral surgery. These interviews were analyzed by a multidisciplinary panel and a scale based on 5 domains, each with 4 outcome statements was constructed. The domains and outcome statements were weighted in terms of importance by a further consecutive sample of 100 patients using resource allocation and visual analog tasks. An additive mathematical formula was applied to the mean weights for each domain and outcome states to produce the final weighted scale. RESULTS: Five domains were identified from the interviews and weighted according to their order of importance (0 to 100 scale; 0 = least important). These were general health and well-being (24.6); impact on home/social life (20.8); health and comfort of the mouth, teeth, and gums (20.0); appearance (18.8); and impact on job/studies (15.8). CONCLUSION: A clinically applicable, multi-attribute outcome scale has been produced that takes into account all determinants of health outcome as perceived by the patient in the context of minor oral surgery. It is completed by selecting a weighted statement from each domain, the sum of which constitutes the patient's health state utility score. The scale has potentially extensive application to both clinical care and research.

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BACKGROUND: How children cope with minor or major surgery is influenced by their attention focus appraisals. Although factors that predict children's coping with surgery have been identified (i.e., age, locus of control, parent-doctor information, worry), it still is not known whether the type of surgery per se affects the coping strategies used and influences previously established predictors of coping. Furthermore, questions remain concerning the relation among type of surgery, attention focus, and coping. OBJECTIVES: The purpose of this study was to determine whether the type of surgery (minor vs. major) would have a differential effect on coping, and whether coping can be predicted better if it is known what type of attention focus (appraisal) the child has. METHODS: Data from three studies of children (n = 189) undergoing minor or major surgery were combined to examine the effects that type of surgery and attention have on coping. Measures included the Preoperative Mode of Coping Interview, Locus of Control Scale for Children, Parent-Doctor Information Interview, and a measure for worry. RESULTS: The results showed that the factors previously found to predict coping were upheld in the combined sample and accounted for 50% of the variance in coping. Type of surgery was significantly associated with coping: Children undergoing minor surgery were somewhat more vigilant than children undergoing major surgery. The inclusion of attention in the analysis significantly improved the variance explained in coping (66%), and children who had a concrete-objective focus of attention were found to be more vigilant. Significant interactions were found between attention focus and type of surgery, locus of control, and age. Type of surgery also had a significant interaction with worry. Children who focused on the concrete-objective aspects of the situation were more vigilant if they were having minor rather than major surgery. Also, children who had an internal locus of control and a concrete-objective focus of attention were more vigilant in coping. Regardless of age, children who had a concrete-objective focus of attention were more vigilant. Furthermore, at low levels of worry, children undergoing major surgery were more vigilant than children undergoing minor surgery. CONCLUSIONS: Coping with surgery is influenced by multiple factors. Children's ability to focus attention on the concrete-objective aspects of surgery may help to reduce feelings of threat that could impede their use of vigilant coping.

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OBJECTIVE: To find the satisfaction of patients undergoing minor surgery at health centres and describe the processes. DESIGN: Retrospective study of population seeking the service. SETTING: Health district. PATIENTS: 160 people who had minor surgery during a year. MEASUREMENTS AND MAIN RESULTS: Descriptive variables of everyone who had minor surgery were analysed: age, sex, type of intervention, pre-surgical diagnosis, anatomical-pathological diagnosis and informed consent. Over three weeks the patients were interviewed by phone with use of a satisfaction questionnaire. 160 interventions took place, 80% of which were then studied histologically, with an 83.16% concordance index. 65% of patients were interviewed. 15% had no telephone, 20% were not found, 95.56% considered they were well attended and 3.17% badly attended. 92.06% would choose the health centre again for procedures of a similar nature. 89.9% thought that the explanations they had received were sufficient. 4.4% thought that the room's hygiene was poor. CONCLUSIONS: Minor surgery in primary care was favourably received by users. Activity at our centre had good anatomical-pathological concordance.

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OBJECTIVE: The primary aim was to determine whether child anxiety could be reduced by the presence of a parent during anaesthetic induction. Secondary aims involved clarification of the effect of the timing of parental separation, the use of premedication, the seriousness of the surgical procedure, and the flow-on effect of parental anxiety on the level of child anxiety. METHODOLOGY: Subjects were obtained by approaching all parents of children aged from 1 to 8 years admitted for day surgery to a private hospital in Adelaide, South Australia during a 3 month period. Data pertaining to 74 children, representing a response rate of 80.4%, were obtained. Parents were instructed to rate the anxiety of their child for the period immediately prior to separation, and to then rate their own anxiety for the same period of time. RESULTS: Children accompanied during induction were less anxious than those who were not accompanied. Contrary to the belief that child anxiety might be reduced by allowing separation in the theatre holding bay area, it was demonstrated that child anxiety was higher in this group than when separation occurred in the ward. No relationship between premedication or operation severity and either child or parental anxiety was observed. However, parental anxiety was noted to be a significant predictor of child anxiety. Suggestions for a more detailed examination of the relationship between child and parental anxiety in future research were outlined. CONCLUSIONS: It was concluded that there are benefits in allowing parents to be present during anaesthetic induction. However, the potential negative effect of parental anxiety must be acknowledged before parents are allowed to accompany their child as a matter of course.

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To investigate the preoperative attitude of surgical patients to regional anaesthesia, 162 subjects scheduled for elective surgery were studied. On the day before operation, patients were interviewed by an anaesthesiologist, using a semi-structured schedule. Topics investigated were sociodemographic variables and clinical correlates, such as past anaesthetic experience, information about anaesthesia and surgery, as well as questions and fears related to anaesthesia. Subjects were assessed for personality characteristics and emotional symptoms by Eysenck's Personality Questionnaire (EPQ), Zung's Self-rating Anxiety and Depression Rating Scales, Schalling-Sifneos' Personality Scale and the 43-item Life Events Inventory of Holmes and Rahe. Seventy-one patients (44%) consented to regional anaesthesia. Consent to regional anaesthesia was associated with advanced age, low neuroticism and high extroversion score in the EPQ, as well as longer duration of illness. The deniers of consent asked more questions and expressed more fears about anaesthesia. It is suggested that the patients' characteristics influence their preference, acceptance or refusal of regional anaesthesia.

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The objectives of this descriptive correlational study were to measure the degree of fear-anxiety in mothers and in their children who were having minor surgery, and then to verify if there was a relationship between these two variables. Other variables examined were: child's age, rooming-in, premedication and child's experience with surgery. Fifty (50) mothers described their emotional states both on the day before and during the surgery. Fifty (50) children between the ages of two (2) and ten (10) years old were observed at five different times (one hour preoperatively, leaving for the OR, pre-induction, coming back to the room and one hour post-operatively). Their behaviours were noted on a new scale, the ECEO: Echelle des comportement de l'enfant opéré. This scale was developed to describe the behaviour of children experiencing fear, anxiety and pain. Results show that the mother's fear-anxiety score was significantly higher during the surgery than before it (t df.49 = 3.77, p < 0.001). Rooming-in significantly affected mothers' emotional states (F = 4.07, p < 0.05). Younger children were more affected than older ones; they also showed more distress when the mother was present (t df.49 = 5.31, p < 0.001). Rooming-in contributed significantly to the child's stress score; children whose mother roomed-in at least one night showed more distress behaviours than children whose mothers did not room-in (t df.48 = 2.03, p < 0.05). A correlation was found between the degree of mothers' fear-anxiety and the children's fear-anxiety-pain score or distress behaviours (r = .28, p < 0.05). A strong relationship was established between the total distress score of the child and his or her score when the mother was present (r = .81, p < 0.01). These results support the theory of social referencing: the child is influenced greatly by the mother's emotional state and he refers to her for the interpretation of events provoking anxiety. Therefore, nurses should inform and support mothers, especially those who are rooming-in; they should also make more use of parents in the preparation and the management of the child for surgery. The development and validation of an instrument measuring fear-anxiety-pain in younger children will facilitate evaluation of the effect of surgery or other procedures on the child, and the planning adequate interventions.

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Hospitalization, regardless of disease, is known to provoke anxiety in the patient admitted for minor surgery. If unrecognized, prolonged anxiety creates stress which may subsequently harm the patient and delay recovery. If nursing intervention is to be therapeutic, it is argued that recognition of and response to this area of patient need should be based on current research findings within the framework of a nursing model. The relationships between pre-operative anxiety, types of coping strategy and information received are discussed with reference to current literature. Open-ended and flexible assessment formats based on Orem's therapeutic self-care requirements and King's open-systems framework are proposed.

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The outcome of day-care versus inpatient surgery for two equivalent groups of children is examined. Ratings were made of medical outcome, behaviour change in the children at 1 week and 3 mths post-discharge from a pre-admission criterion, convenience and subjective anxiety for parents, and relative costs of the two procedures. Results showed trends in favour of the day-care procedure. Argument is made that day-care should be the preferred option for minor surgery in young children.

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