title: Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: a quantitative systematic review.
abstract: OBJECTIVE
  To examine the relationship between perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures and the differences in children's perioperative anxiety and postoperative pain among subgroups of demographics.
  
  
  BACKGROUND
  While anxiety and pain are regarded as two common problems experienced by children and adolescents perioperatively and the relationship between them has been reported in previous studies, there has been no review paper examining this phenomenon.
  
  
  METHODS
  A quantitative systematic review.
  
  
  METHODS
  Nine electronic databases were searched for studies published in English from the inception date of the databases to December 2010, using various combinations of search terms of 'adolescents', 'anxiety', 'child', 'pain', 'surgery' and 'correlation/relationship'.
  
  
  METHODS
  Using the Joanna Briggs Institute's comprehensive systematic review strategies, relevant studies were independently appraised and extracted by two reviewers using the standardized critical appraisal instruments and data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument.
  
  
  RESULTS
  Ten studies were included in this review from 943 studies initially retrieved. Children and adolescents who had higher level of perioperative anxiety experienced a higher level of postoperative pain. Inconclusive evidence was found regarding differences of perioperative anxiety and postoperative pain between demographic subgroups of gender, age and past surgical experience.
  
  
  CONCLUSIONS
  Results of this review inform healthcare providers of the role perioperative anxiety plays on children's and adolescents' postoperative pain and indicate the need to use interventions to reduce perioperative anxiety and, therefore, optimize their postoperative pain management during the perioperative period.
authors.affiliation: Division of Nursing, National University Hospital, Singapore.
authors.forename: Ying Jia Shermin
authors.initials: YJ
authors.lastname: Chieng
authors.forename: Wai Chi Sally
authors.initials: WC
authors.lastname: Chan
authors.forename: Piyanee
authors.initials: P
authors.lastname: Klainin-Yobas
authors.forename: Hong-Gu
authors.initials: HG
authors.lastname: He
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000209:etiology* / Q000517:prevention & control*; D002648:Child; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control* / Q000523:psychology
keywords: adolescents; anxiety; children; elective surgical procedure; nursing; pain; perioperative; postoperative; surgery; systematic review