Identification and Treatment of Pediatric Perioperative Anxiety

Children experience heightened anxiety and fear in the hospital.^1,2  Perioperatively, these feelings are amplified by a loss of control and separation from their caregivers.³  Due to the high incidence of needle-phobia in two-thirds of the pediatric population, most children undergo inhalation induction when presenting for anesthesia. However, needle avoidance only partially mitigates preoperative anxiety since introduction of the mask during inhalational induction is also associated with significant distress, often requiring physical restraint.⁴  Sequalae of undertreated pediatric perioperative anxiety include increased anesthetic requirements, pain perception, and emergence delirium, as well as decreased parental satisfaction.^5,6  Physiologic responses to stress during anesthesia induction can trigger increased cortisol and susceptibility to postoperative infections due to immune function dysregulation.^7–9  Long-term postoperative maladaptive behaviors can occur, including enuresis, sleep disturbances, post-traumatic stress, fear of hospital settings, and generalized anxiety^1,10  Healthcare-induced distress predisposes children to...