Anxiety reaction in children during removal of their plaster cast with a saw.
We have had experience of an 18-month-old boy with a cardiomyopathy who died a few minutes after removal of his cast with a saw, apparently from a malignant cardiac arrhythmia triggered by anxiety. We therefore examined the anxiety reaction to this method of removal of a plaster cast in 20 healthy children; ten were provided with hearing protectors and ten were not. The level of anxiety was assessed by measuring the heart rate, a known physiological indicator of anxiety, before, during and five minutes after removal of the cast. The noise level was also measured. The results showed a mean increase in heart rate during the procedure of 27.9 beats per minute (bpm) (26.9%) in the children with no hearing protectors and 10.4 bpm (11.1%) in children who used hearing protectors (p < 0.001). Five minutes after the procedure the heart rate had returned to the baseline rate in all patients. We recommend that hearing protectors should be used in children undergoing removal of a plaster cast to decrease the anxiety reaction. If possible, clinicians should avoid the use of a saw for this purpose in children with a cardiomyopathy.
Katz
K
K
Schneider Children's Medical Centre, Petah Tiqva, Israel.
Fogelman
R
R
Attias
J
J
Baron
E
E
Soudry
M
M
D001007:Anxiety / Q000209:etiology* / Q000517:prevention & control; D009202:Cardiomyopathies / Q000150:complications; D002370:Casts, Surgical; D002648:Child; D004430:Ear Protective Devices; D005260:Female; D006339:Heart Rate; D006801:Humans; D007223:Infant; D008297:Male; D009622:Noise / Q000009:adverse effects*