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Children's play after anaesthesia and surgery: background factors and associations to behaviour during anaesthetic induction
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
2010 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 14, no 2, 170-178 p.Article in journal (Refereed) Published
Abstract [en]

Children can experience anaesthetic induction as fearful and frightening and this can lead to postoperative behaviour changes and symptoms of high anxiety. A fearful experience can also lead to avoidant reactions due to raised negative emotions in situations similar to that, which evoked the fear. To analyse children’s reactions after anaesthesia to anaesthetic play equipment, 49 children (three—six years old) were video-filmed during play with anaesthetic equipment 14 days after anaesthesia and surgery. The risk that the child avoided playing with anaesthetic equipment was increased if the child took the premedication unwillingly and if the child was younger. The risk for not telling about the experience was increased if the child took the premedication unwillingly and if the child showed signs of shyness. The risk for telling mostly unspecific memories increased if the child was younger and if the child showed signs of shyness. Avoidant reactions could bee seen in 50 percent of the children. It is important to be aware of the characteristics of a vulnerable child (age, shyness) and to meet the child without raising negative emotions in any part of the anaesthetic process, in order to avoid negative reactions in future encounters.

Place, publisher, year, edition, pages
Sage Publications, 2010. Vol. 14, no 2, 170-178 p.
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-17364DOI: 10.1177/1367493509359225ISI: 000281503600005PubMedID: 20212059OAI: oai:DiVA.org:liu-17364DiVA: diva2:208830
Note

At the time of presentation of the thesis was the article in the status "submitted"

Available from: 2009-03-20 Created: 2009-03-20 Last updated: 2017-12-13Bibliographically approved
In thesis
1. The Process of Anaesthetic induction with Children
Open this publication in new window or tab >>The Process of Anaesthetic induction with Children
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anaesthetic induction is one of the most stressful experiences a child can have during hospitalization. High anxiety is seen in 50–60% of the children and is associated with less compliance/cooperation during anaesthetic induction. It can also lead to behaviour problems after surgery.

Important factors that are associated with high anxiety are younger age, withdrawn shy temperament, previous negative experience in the hospital and certain kinds of adult behaviour. This thesis has been done to further illuminate the anaesthetic process and gain more knowledge about child behaviour, parent and staff communication, nurse anaesthetist decision-making communication and the reactions of children after anaesthesia and surgery.

Materials/Methods: One-hundred and two children between the ages of 3–6 that were scheduled for ENT surgery were video filmed. Screening instruments about child behaviour, fears and parental anxiety were used before the anaesthetic procedure. All children were video filmed during the process until they were at asleep. Parents were interviewed during the operation. Forty-nine children came 14 days after the surgery for a play session that also was video filmed. The video films were then analysed to identify critical situations and behaviours. Parents and nurse communication were categorized. Decision-making communications from the nurse anaethetist were also identified and categorized.

Results: Four critical situations or reactions were identified, premedication, degree of sedation, compliance during needle insertion or mask on child´s face and the child’s reactions when going to sleep. Each of the situations influenced the next following situation, predicting a higher risk for developing a vicious circle. The first (taking the premedication) was predicted by earlier traumatic hospital experience, if the child placed him/herself nearby or in parent’s lap, hesitant eye contact and highly active parents. The most common type of decision-making category was information, followed by negotiation. Unwillingness to take premedication was associated with more negotiation and less information. A child who takes premedication unwillingly had more often avoidant reactions toward anaesthetic equipment and anaesthetic play after surgery. An anaesthetic induction process is complex and transactional. Previous experience will together with the process of anaesthesia create a new learning history.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1099
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17365 (URN)978-91-7393-701-6 (ISBN)
Public defence
2009-02-27, Qulturum, Länssjukhuset Ryhov, Jönköping, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-20 Created: 2009-03-20 Last updated: 2009-08-21Bibliographically approved

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Proczkowska-Björklund, MarieGustafsson, Per A.Svedin, Carl Göran

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