title: Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery.
abstract: OBJECTIVE
  Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children.
  
  
  METHODS
  We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy. Before surgery, we assessed child and parental situational anxiety and temperament. After surgery, all subjects were admitted to a research unit in which postoperative pain and analgesic consumption were assessed every 3 hours. After 24 hours in the hospital, children were discharged and followed up at home for the next 14 days. Pain management at home was standardized.
  
  
  RESULTS
  Parental assessment of pain in their child showed that anxious children experienced significantly more pain both during the hospital stay and over the first 3 days at home. During home recovery, anxious children also consumed, on average, significantly more codeine and acetaminophen compared with the children who were not anxious. Anxious children also had a higher incidence of emergence delirium compared with the children who were not anxious (9.7% vs 1.5%) and had a higher incidence of postoperative anxiety and sleep problems.
  
  
  CONCLUSIONS
  Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.
authors.affiliation: Center for the Advancement of Perioperative Health, Department of Anesthesiology, Yale University School of Medicine, PO Box 208051, 333 Cedar St, New Haven, Connecticut 06521, USA. zeev.kain@yale.edu
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
authors.forename: Linda C
authors.initials: LC
authors.lastname: Mayes
authors.forename: Alison A
authors.initials: AA
authors.lastname: Caldwell-Andrews
authors.forename: David E
authors.initials: DE
authors.lastname: Karas
authors.forename: Brenda C
authors.initials: BC
authors.lastname: McClain
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000233:Adenoidectomy / Q000523:psychology*; D000700:Analgesics / Q000627:therapeutic use; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D002675:Child, Preschool; D003061:Codeine / Q000627:therapeutic use; D003693:Delirium / Q000453:epidemiology / Q000209:etiology; D017558:Elective Surgical Procedures / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009730:Nursing Assessment; D015588:Observer Variation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D002666:Psychology, Child; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D014068:Tonsillectomy / Q000523:psychology*
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D003061:Codeine