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The Process of Anaesthetic induction with Children
Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry .
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Important factors that are associated with high anxiety are younger age, withdrawn shy temperament, previous negative experience in the hospital and certain kinds of adult behaviour.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: urn:nbn:se:liu:diva-17365ISBN: 978-91-7393-701-6 (print)OAI: oai:DiVA.org:liu-17365DiVA: diva2:208833
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
List of papers
1. Child related background factors affecting compliance with induction of anaesthesia.
Open this publication in new window or tab >>Child related background factors affecting compliance with induction of anaesthesia.
2004 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 14, no 3, 225-234 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Factors such as age, sex, behaviour problems, fears, earlier traumatic hospital events and reactions to vaccination were assessed together with behaviour observed before premedication in order to evaluate their importance in predicting response to the anaesthetic process. The anaesthetic process was divided into four endpoints; compliance when given premedication, sedation, compliance during needle insertion or when an anaesthetic mask was put in place and behaviour when put to sleep.

METHODS: A total of 102 children who were undergoing day-stay surgery and overnight stay surgery were video-filmed during premedication and anaesthetic induction. Before premedication the children and parents answered questionnaires about behaviour [Preschool Behaviour Check List (PBCL)] and fears [Fears Survey Schedule for Children-Revised (FSSC-R)]. The films were analysed to assess behaviour before and after premedication and during induction of anaesthesia. A semistructured interview was conducted with the parents during the time the children were asleep. '

RESULTS: There was a significantly higher odds ratio for noncompliant behaviour during premedication if the child placed itself in the parent's lap or near the parent or had previously experienced traumatic hospital events. The odds ratio for not being sedated by premedication was higher if compliance was low when premedication was given or the child had experienced a traumatic hospital event in the past. A high odds ratio for noncompliant behaviour during venous access or placement of an anaesthetic mask was seen if the child was not sedated or the child had had a negative reaction when vaccinated. The odds ratio for falling asleep in an anxious or upset state was higher if the child had shown noncompliant behaviour during premedication, had not been sedated or had shown noncompliant behaviour during venous access or facemask placement.

CONCLUSIONS: The overall most important factor that predicts noncompliant behaviour and a distressed state in the child during the anaesthetic process was the experience of earlier traumatic hospital events including negative reaction to vaccination. All elements of the process are important in determining what will happen and all steps will influence how the child reacts when put to sleep.

Place, publisher, year, edition, pages
Wily InterScience, 2004
Keyword
Children, background factors, compliance, anaesthesia induction
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17359 (URN)10.1046/j.1460-9592.2003.01185.x (DOI)14996261 (PubMedID)
Available from: 2009-03-20 Created: 2009-03-20 Last updated: 2017-12-13Bibliographically approved
2. Communication and child behaviour associated with unwillingness to take premedication.
Open this publication in new window or tab >>Communication and child behaviour associated with unwillingness to take premedication.
2008 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 9, 1238-1242 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To see how dominance in adult communication and child behaviour during premedication affects the child's unwillingness to take premedication.

Method: Ninety-five children scheduled for ENT surgery were video-filmed during premedication. All communication was translated verbatim and the communication was grouped according to; if the parent or nurse directed their communication towards the child or not, or; if they talked about nonprocedural matters or procedural matters.

Results: Unwillingness to take premedication was associated with more parent communication and less anaesthetic nurse communication compared to willingness to take premedication. There was a heighten risk that the child took their premedication unwillingly if their parent talked more directly to the child (OR = 4.9, p < or = 0.01), the child gave hesitant eye contact with the anaesthetic nurse (OR = 4.5, p < or = 0.05), the child had experienced an earlier traumatic medical procedure (OR = 4.1. p < or = 0.001) or if the child placed her/himself nearby their parent (OR = 4.0, p < or = 0.001).

Conclusion: Together with behaviour that could be signs of shyness and earlier medical traumatic experience, parents that are actively communicating with their child before premedication may heighten the risk that the child will take the premedication unwillingly.

Place, publisher, year, edition, pages
WileyScience, 2008
Keyword
Behaviour, Child, Compliance, Communication, Premedication
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17362 (URN)10.1111/j.1651-2227.2008.00896.x (DOI)18540904 (PubMedID)
Available from: 2009-03-20 Created: 2009-03-20 Last updated: 2017-12-13Bibliographically approved
3. Decision making about pre-medication to children.
Open this publication in new window or tab >>Decision making about pre-medication to children.
2008 (English)In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 34, no 6, 713-720 p.Article in journal (Refereed) Published
Abstract [en]

Background: Inviting the child to participate in medical decisions regarding common medical procedures might influence the child's behaviour during the procedures. We wanted to study nurse decision-making communication regarding pre-medication before ear, nose and throat (ENT) surgery.

Method: In total, 102 children (3-6 years) signed for ENT surgery were video-filmed during the pre-medication process. The nurse decision-making communication was identified, transcribed and grouped in six main categories dependent on the level of participation (self-determination, compromise, negotiation, questioning, information, lack of communication). Associations between child factors (age, gender, verbal communication and non-verbal communication) and different nurse decision-making communication were studied. Associations between the decision-making communication and verbal hesitation and/or the child's compliance in taking pre-medication were also studied.

Results: Totally, information was the most frequently used category of decision making communication followed by negotiation and questioning. To the children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more compromise, negotiation and gave less information to children with less compliance. No specific type of nurse decision-making communication was associated with verbal hesitation. The most important predictors for verbal hesitation were none or hesitant eye contact with nurse (OR = 4.5) and placement nearby or in parent's lap (OR = 4.7). Predictors for less compliance in taking pre-medication were verbal hesitation from the child (OR = 22.7) and children who did not give any verbal answer to nurse initial questions (OR = 5.5).

Conclusion: Decision-making communication could not predict the child's compliance during pre-medication. Although negotiation, questioning and self-determination communication were associated with more unwillingness to take pre-medication. More knowledge is needed about communication to children in medical settings and how it influences the child's behaviours.

Place, publisher, year, edition, pages
WileyInterScience, 2008
Keyword
Anaesthesia premedication, children, compliance, decision-making communication
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17363 (URN)10.1111/j.1365-2214.2008.00853.x (DOI)18959568 (PubMedID)
Available from: 2009-03-20 Created: 2009-03-20 Last updated: 2017-12-13Bibliographically approved
4. Children's play after anaesthesia and surgery: background factors and associations to behaviour during anaesthetic induction
Open this publication in new window or tab >>Children's play after anaesthesia and surgery: background factors and associations to behaviour during anaesthetic induction
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
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-17364 (URN)10.1177/1367493509359225 (DOI)000281503600005 ()20212059 (PubMedID)
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

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