Examining anxiety and experiences of children, parents and staff in the perioperative environment through qualitative interviews.

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Millions of children undergo anaesthesia for surgical procedures around the world every year. Medical encounters can be an anxiety inducing experience for children, particularly when invasive procedures are performed, as happens for anaesthetic induction. Children can find the induction experience unpleasant because they are in an unfamiliar environment, with unfamiliar people and/or they have an aversion to needles or because they may find the anaesthetic gas mask intrusive and frightening. Preoperative anxiety is a common and unfavourable manifestation in children and has been reported in 50 – 80% of children and can be characterised by feelings of apprehension, tension and worry and can stem from reasons including fear of the unknown, anticipation of separation from parents, fear of potential pain and fear of loss of control. High levels of preoperative anxiety are associated with both physiological and psychological adverse outcomes in children such as significantly higher postoperative pain, increased anaesthetic use, a higher incidence of emergence delirium, prolonged recovery, and lengthened hospitalisations. These outcomes have detrimental effects on patients. Moreover, negative postoperative impacts of preoperative anxiety include maladaptive behaviours, such as nightmares, separation anxiety, increased fear of doctors and eating disorders. Pharmacological interventions are currently the most common approach used to manage preoperative anxiety. However, there are some limitations to this method. Virtual-reality and video-based technology has been demonstrated to be acceptable and effective in minimising anxiety through both acting as a distraction and as an interactive means to acclimatise to the perioperative setting. Paediatric anaesthetists often use distraction techniques such as conversation or humour to mediate anxiety. Maintaining parental presence during the induction of anaesthesia is another regularly used approach to help support paediatric patients. These social support methods have their benefits and challenges, but with limited overall anxiolysis. The objectives of this project are to identify key themes related to children’s, parent’s, staff and volunteer lived experiences of and views regarding anxiety in acute settings, particularly in the perioperative environment at Perth Children’s Hospital. The ANTELOPE study will improve our understanding of children’s’ anxiety in the perioperative setting to inform the adaptation and implementation of the perioperative Magic Coat program for use at Perth Children’s Hospital.

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