LAUSR

Dear Editor, Preoperative anxiety is characterized by the patient’s experience of Bbeing stressed and anxious^ while awaiting surgery. As Perks, Chakravarti and Manninen indicated in their original study [1], the incidence of preoperative anxiety in neurosurgery patients was 89%, while the 55% diagnosed with a high level of anxiety. Patients’ anxiety mainly related to concerns about surgical factors, such as results of the operation and the possible physical injuries or mental suffering, while a small proportion of the patients reported anxiety due to the anesthesia procedure. It was pointed out that patients who experienced a high level of anxiety, presented more worries about the operation and needed more information about the surgical procedure. Although neurosurgical interventions and their outcome are great sources of anxiety for patients, little attention has been given on this field. Relative to this notion, we state that the research is even more scarce in pediatric patients [1]. Young patients come up with many emotional and physical challenges when preparing for surgery. It has been argued that preoperative procedures such as venipuncture, anesthesia induction, pre-surgical injection, and parting from the parents, may provoke fear, anxiety, distress, and physical pain to the pediatric patients [2]. Similar to these findings, Wennstrom, Hallberg, and Bergh carried out interviews in children undergoing day surgery and supported that prior to the surgery, children’s anxiety was related to fears about the Bunknown^ and feelings of insecurity and uncertainty about surgical procedure and potential postoperative discomfort [3]. Furthermore, preoperative anxiety may lead to adverse postoperative outcomes. Kain et al. found in their study [4] that children rated high in preoperative anxiety measures experienced more postoperative pain, consumed more analgesics, and had a higher incidence of postoperative anxiety and sleep disturbances, than children who were not anxious. Interestingly enough, little attention has been given in regard to preoperative anxiety in pediatric neurosurgery patients. A noteworthy study conducted by Chieng et al. [5], clarified that in children undergoing many types of surgery, including neurosurgery, preoperative anxiety may be related to negative emotional behaviors. Additionally, children who experienced anxiety prior to the surgery, had more postoperative pain [5]. A more recent paper of Riquin et al. [6], examined the psychological impact of surgery while awake in children for resection of brain tumors. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress. As authors quoted Bthe results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect^ [6]. Moreover, it has been found that parental anxiety may increase the preoperative anxiety in children [7]. Under those circumstances, there is an imperative need for the implementation of effective preparation programs in the medical environment. Looking beyond the Btraditional^ anesthetic care and pharmacological interventions, children facing preoperative anxiety need psychological support as well as extensive information about the surgery, possible pain effects, anesthesia, and thorough informing about the pre-surgical procedures, the perioperative medical environment, and potential detrimental outcomes [8]. As Chow et al. suggested in their recent review [9], preoperative anxiety symptoms in children may be effectively alleviated by audiovisual interventions such as providing comprehensive procedural information through interactive videos and games and multi-faceted programs. The effectiveness of such interventions can be amply demonstrated by a randomized clinical trial where the use of * Nikolaos Ch. Syrmos [email protected]