Pre operative anxiety and its contributing factors in pediatric patients’ parents undergoing surgery

Mehrdad Hosseinpour, Somayeh Abedi, Mohadese Hamsayeh, Bahareh Ahmadi



Introduction: Hospitalization and surgery are among the most difficult experiences which children and their parents have to face. Many parents experience preoperative anxiety during the hospitalization of their children. This study attempts to assess preoperative anxiety in parents of children admitted for elective surgery and to evaluate factors associated with increased anxiety. 

Material and Methods: In a cross-sectional study, all parents consecutively admitted to the study hospitals (Shahid Beheshti hospital in kashan and Imam Hossein hospital in Esfahan) were assessed. We used standard anxiety assessment questionnaires [Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Spielberger’s State-Trait Anxiety Inventory (STAI)] to quantify the anxiety of parents just before their child entered the operative theater. For mean comparison between variables, independent t-test, ANOVA and Chi-square analysis were used. Multiple regressions were conducted to determine the factors attributed to pre operative anxiety. A P-value of less than 0.05 was considered significant.

Results: In this study 100 parents (60 cases from Shahid Beheshti hospital and 40 patients from Imam Hossein hospital) were evaluated. The mean anxiety score was 51.05±1.19 for STAI, 15.27±2.83 for APAIS (anxiety), and 8.07±1.7 for APAIS (information) respectively. Parents education was a factor that significantly affected the STAI (p=0.042), but its effect on APAIS was not significant. In regression analysis for anxiety severity, child age was a significant factor of anxiety status (p=0.043).

Conclusions: This study showed that anxiety is relatively high in our centers and parent’s education and children age are the most important predictive factors for this condition


Spielbergers State-Trait Anxiety Inventory test; Amesterdam Preoperative Anxiety and Information Scale; Pre operative Anxiety

Full Text:




¬- Litke J, Pikulska A, Wegner T: Management of perioperative stress in children and parents. Part I the preoperative period. Anaesthesiol Intensive Ther 2012; 44(3):165-9.

- ¬Pritchard MJ: Identifying and assessing anxiety in pre¬operative patients. Nursing Standard 2009; 23(51): 35¬40.

- Tluczek A, Henriques JB, Brown RL: Support for the Reliability and Validity of a Six-Item State Anxiety Scale Derived From the State¬Trait Anxiety Inventory. J Nurs Meas 2009; 17(1): 19–28.

¬- Eloise Cl: Patterns and frequency of anxiety in women undergoing gynaecological surgery. J Clin Nurs 2006; 15(3): 341-¬352.

- ¬Karanci AN, Dirik G. Predictors of Pre¬and Postoperational Anxiety in Emergency Surgery Patients. J Psychosom Res 2003; 55(4):36-3¬9.

- Berghmans J, Weber F, van Akoleyen C, et al: Audiovisual aid viewing immediately before pediatric induction moderates the accompanying parents› anxiety. Paediatr Anaesth 2012; 22(4):386-92.

- Grieve RJ: Day surgery preoperative anxiety reduction and coping strategies. Br J Nurse 2002; 11(10):670¬ 678.

¬- Stirling L, Raab G, Alder EM, et al: Randomized trial of essential oils to reduce perioperative patient anxiety: feasibility study. J Adv Nurs 2007; 60(5): 494¬-501.

¬- Spaulding NJ: Reducing anxiety by pre¬operative education: make the future familiar. Occup Ther Int 2003; 10(4):278¬-293

¬- Starkweather AR, Witek¬Janusek L, Nockels RP, et al: Immune function, pain and psychological stress in patients under-going spinal surgery. Spine 2006; 31(18): 641¬-647.

- Watson AT, Visram A: Children›s preoperative anxiety and postoperative behavior. Paediatr Anaesth 2003; 13(3):188-204. 12- Kain ZN, Caldwell-Andrews AA, Mayes LC, et al: Parental presence during induction of anesthesia: physiological effects on parents. Anesthesiology 2003; 98(1):58-64.

- Caldwell-Andrews AA, Kain ZN, Mayes LC, et al: Motivation and maternal presence during induction of anesthesia. An-esthesiology 2005; 103(3):478-83.

- Kain ZN, Caldwell-Andrews AA, Maranets I, et al: Predicting which child- parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach. Anesth Analg 2006; 102(1):81-4.

-Kain ZN, Caldwell¬Andrews AA, Mayes LC, et al: Family ¬centered preparation for surgery improves perioperative out-comes in children: a randomized controlled study. Anesthesiology 2007;106(1):65-¬74.

MacLaren JE, Kain ZN: Development of a brief behavioral intervention for children’s anxiety at anesthesia induction. Child Health Care 2008;37(3):196¬-209.

- Perpiñá¬Galvañ J, Cabañero¬Martínez MJ, Richart¬Martínez M: Reliability and validity of shortened state trait anxiety inventory in Spanish patients receiving mechanical ventilation. Am J Crit Care 2013; 22(1):46-52.

- ¬Hosseinpour M, Memarzadeh M: Use of a preoperative playroom to prepare children for surgery. Eur J Pediatr Surg 2010; 20(6):408-¬11.

- Nikandish R, Anvar M, Avand A, et al: Translation and validation of the amsterdam preoperative anxiety and information scale (APAIS) for Iranian population Pajouhesh Dar Pezeshki 2007; 31(1):79-¬84.

¬- Kain Zn, Maclaren J, Mayes Lc: Perioperative behavior stress in children. In: Cote

CJ, Lerman J, and ID Todres, Eds. A Practice of Anesthesia for Infants and Children. Philadelphia, PA: Saunders Elsevier; 2009, 27.

- Ahmed M, Farrell MA, Parrish K, et al: Preoperative anxiety in children risk factors and non¬-pharmacological manage-ment. M.E.J. ANESTH 2011;21 (2) :153-170.

¬- Bevan JC, Johnston C, Haig MJ, et al: Preoperative parental anxiety predicts behavioral and emotional responses to in-duction of anaesthesia in children. Can J Anaesth 1990; 37(2):177-82.

- Thompson N, Irwin MG, Gunawardene WM, et al: Pre-operative parental anxiety. Anaesthesia 1996; 51(11):1008-12. 24- Ebirim L, Tobin M: Factors Responsible For Pre¬-Operative Anxiety In Elective Surgical Patients At A University Teach-ing Hospital: A Pilot Study. Intern J Anesthesiol 2011; 29(2): 5580-1584.

¬- Kain ZN, Mayes LC, O›Connor TZ, Cicchetti DV: Preoperative anxiety in children. Predictors and outcomes. Arch Pedi-atr Adolesc Med1996; 150(12):1238¬-45

- Tsai p, Tak S, moore C, et al: Testing a theory of chronic pain. J Adv Nurs 2003;43(2) :158-¬169.



  • There are currently no refbacks.

pISSN: 2423-5067

eISSN: 2423-7612

Creative Commons License
This journal and its contents are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.