Psychological Preparation of the Pediatric Patient for Surgery

Each year, about six million children undergo surgical procedures in the United States. More than 80% of all pediatric procedures in the United States are on an outpatient basis without hospital preoperative or postoperative admission. More than 60% of these children manifest emotional distress prior to the procedures and at the induction of anesthesia. The intense distress may lead to negative postoperative physiological and psychological outcomes in children and affect parental satisfaction. Preoperative stress can also exaggerate negative memories, which can exaggerate distress at subsequent procedures. Studies have looked into the incorporation of pharmacological agents as well as nonpharmacological strategies such as parental presence, and behavioral techniques such as imagery, relaxation, and hypnosis in the management of preoperative anxiety. The goal of this chapter is to examine the effects of preoperative anxiety and the effectiveness of these strategies in preventing preoperative psychological stress in children.