护理人员准备视频(Take5)对麻醉诱导过程中儿童焦虑的影响:一项随机对照试验。

IF 1.7 4区 医学 Q2 ANESTHESIOLOGY
Pediatric Anesthesia Pub Date : 2025-11-01 Epub Date: 2025-06-27 DOI:10.1111/pan.70006
Erin Brown, Krittika Vongkiatkajorn, Vanessa Rich, Justin Kenardy, Alexandra Donaldson, Rebecca Paterson, Cameron Graydon, Paul Lee-Archer
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引用次数: 0

摘要

背景:全麻可引起焦虑,经历围手术期焦虑的儿童更有可能出现负面结果,如出现谵妄、镇痛需求增加和适应不良行为。麻醉诱导时父母在场有助于减轻焦虑;然而,只有父母自己不感到焦虑,并能以积极的方式支持他们的孩子。本研究的目的是测试一个简短的准备视频针对护理人员在儿童诱导麻醉之前的效果。方法:我们进行了一项随机对照试验,将Take5视频与标准治疗进行比较。Take5的视频是由儿科麻醉师、儿童心理学家和一个由经历过手术和麻醉的儿童家长组成的消费者小组制作的。Take5视频是一个5分钟的动画视频,为护理人员准备麻醉诱导过程中的预期情况。它还为照顾者提供了在诱导过程中积极支持儿童的建议行为和管理个人痛苦的心理应对策略。参与者被随机分为标准准备组和干预组,干预组包括标准准备和护理人员在术前等候区观看Take5视频,然后陪同他们的孩子进入手术室。主要终点是儿童诱导时的焦虑,使用改良的耶鲁术前焦虑量表-短表(mYPAS-SF)测量。次要结局为护理人员程序性行为、儿童术后疼痛、出现性谵妄、出院时间、护理人员满意度以及3个月时护理人员和儿童的心理健康状况。结果:100名儿童和他们的照顾者被招募到试验中。所有观察者量表的评分间信度均为良好至优异(mYPAS-SF的类内相关系数= 0.81)。对于诱导麻醉时儿童焦虑的主要结局,有很好的证据表明两组之间没有差异。对于次要结果,视频干预对父母行为没有任何影响。组间疼痛评分差异有统计学意义,对照组儿童在面部、腿部、活动、哭泣和安慰(FLACC)量表上的疼痛程度更高(平均差异0.6,95% CI 0.04-1.16, p = 0.037)。在任何其他次要结果,包括出现谵妄,出院时间或照顾者满意度没有显示差异。在3个月的心理健康结果方面也没有任何差异:儿童健康相关的生活质量、儿童行为困难或父母抑郁和焦虑得分。尽管如此,在半结构化的采访中,护理人员报告说视频是可以接受的,有益的,但许多人更愿意在孩子手术前几天看到它。讨论:手术前立即向护理人员播放的Take5视频,对诱导时的儿童焦虑或一系列术后结果没有任何明显的影响;然而,照顾者报告了对孩子的诱导体验的感知益处。这项研究的结果并没有显示出Take5视频的可衡量的好处;然而,这可能是由于交付的时间。在进入医院之前向家庭提供这种资源可能是有益的;然而,需要进一步的研究来证实这一点。试验注册:本研究在https://www.anzctr.org.au/注册(ACTRN12621001337864;2021年10月5日)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Effect of a Caregiver Preparation Video (Take5) on Child Anxiety During Anesthetic Induction: A Randomized Controlled Trial.

Background: A general anesthetic can be an anxiety-provoking experience, and children who experience perioperative anxiety are more likely to have negative outcomes such as emergence delirium, increased analgesic requirements, and maladaptive behaviors. Parental presence at the induction of anesthesia can help reduce anxiety; however, only if the parent does not feel anxious themselves and can support their child in a positive way. The aim of this study was to test the efficacy of a short preparation video aimed at caregivers prior to the child's induction of anesthesia.

Methods: We conducted a randomized controlled trial of the Take5 video compared to standard care. The Take5 video was developed by pediatric anesthetists, child psychologists and a consumer panel of parents of children who had lived experience of surgery and anesthesia. The Take5 video is a 5-min, animated video that prepares caregivers for what to expect during the anesthetic induction. It also provides the caregiver with suggested behaviors that will positively support the child during the induction and psychological coping strategies to manage personal distress. Participants were randomized to the standard preparation group or the intervention group, which consisted of standard preparation plus the caregiver being shown the Take5 video in the preoperative waiting area prior to accompanying their child to the operating room. The primary outcome was child anxiety at induction measured using the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes were caregiver procedural behavior, child postoperative pain, emergence delirium, time to discharge, caregiver satisfaction and caregiver and child psychological wellbeing at 3 months.

Results: One-hundred children and their caregivers were recruited to the trial. There was good to excellent inter-rater reliability with all of the observer scales (intraclass correlation coefficient = 0.81 for the mYPAS-SF). For the primary outcome of child anxiety at induction of anesthesia, there was good evidence for no difference between groups. For the secondary outcomes, the video intervention did not show any effect on parental behavior. There was a statistically significant difference in pain scores between groups, with children in the control group rated as having more pain on the Faces, Legs, Activity, Cry and Consolability (FLACC) scale (mean difference 0.6, 95% CI 0.04-1.16, p = 0.037). There was no difference shown in any of the other secondary outcomes including emergence delirium, time to discharge or caregiver satisfaction. There were also no differences in any of the 3-month psychological wellbeing outcomes: Child health-related quality of life, child behavioral difficulties or parent depression and anxiety scores. Despite this, in semistructured interviews, caregivers reported the video to be acceptable and beneficial, but many would have preferred to see it in the days prior to their child's procedure.

Discussion: The Take5 video, shown to caregivers immediately prior to surgery, did not have any demonstrable effect on child anxiety at induction or on a range of postoperative outcomes; however, caregivers reported a perceived benefit to the child's induction experience. The results of this study did not show a measurable benefit of the Take5 video; however, this may be due to the timing of delivery. Providing this resource to families prior to coming into the hospital may be of benefit; however, further studies would be required to confirm this.

Trial registration: This study was registered in https://www.anzctr.org.au/ (ACTRN12621001337864; October 5, 2021).

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来源期刊
Pediatric Anesthesia
Pediatric Anesthesia 医学-麻醉学
CiteScore
3.20
自引率
11.80%
发文量
222
审稿时长
3-8 weeks
期刊介绍: Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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