Preoperative Anxiety in Adolescents Undergoing Surgery: a Pilot Study

Objectives: The purpose of this study was to conduct a prospective assessment of preoperative anxiety in adolescents undergoing surgery.

Aim:   To systematically conduct a multimodal evaluation of preoperative anxiety in adolescents undergoing surgery.

Background: The existing literature on preoperative anxiety in children has overwhelmingly ignored adolescents in the surgical setting, yet adolescents may be at risk for undertreatment of preoperative anxiety.

Methods: A total of 59 adolescents aged 11-18 were recruited. Behavioral and physiological manifestations of anxiety were assessed with a visual analog scale and an ambulatory physiological data recorder that collected heart rate (HR), skin conductance level (SCL), and blood pressure data. Baseline emotional and behavioral functioning (child behavior checklist [CBCL]) as well as temperament (early adolescent temperament questionnaire-revised--parent version) and other potential risk factors were also assessed.

Results: Over 80% of adolescents reported significant anxiety at the time of induction. Self-reported anxiety increased significantly at each time point (holding, separation from parents, and mask introduction), P=0.001. Significant increases in both HR (P=0.02) and SCL (P<0.001) were found from holding to mask introduction. Several risk factors were found to predict higher anxiety at mask introduction, including baseline anxiety and depression (CBCL, Internalizing, P=0.04), somatizing problems (P=0.05), and fearful temperament (P=0.03).

Conclusions: A large proportion of adolescents experience significant anxiety that increases from the preoperative holding area to anesthesia induction. Underlying baseline anxiety and depression as well somatization and fearful temperament are predictors of this phenomenon.