Perioperative Psychological Trauma

Definition

The perioperative period is frequently an extremely traumatic time for both children and parents. Subjective feelings of tension, apprehension, and worry characterize preoperative anxiety in children. Preoperative anxiety stimulates sympathetic, parasympathetic, and endocrine systems, leading to increases in heart rate, blood pressure, and cardiac excitability. These reactions reflect the child’s fear of separation from parents and the home environment, loss of control, and fear of unfamiliar routines, surgical instruments, and hospital procedures. Thus it is no surprise that up to 65% of all children undergoing anesthesia and surgery develop extreme anxiety and fear during the perioperative period.

Of perhaps greater importance than the child’s behavior in the preoperative holding area is the child’s behavior after the surgery. Clinicians and investigators have long recognized postoperative psychological reactions such as general anxiety, nighttime crying, enuresis, separation anxiety, and temper tantrums. These behavioral changes are of particular concern if they persist for an extended period and negatively affect the child’s responses to subsequent medical care or interfere with his or her emotional and cognitive development.