Page 32 - CASA Bulletin of Anesthesiology Vol 9 (4) 2022 (3)

CASA Bulletin of Anesthesiology

Magic and Midazolam: How Child Life specialist and Anesthesia

Make the Perfect Pair

Makenna Peterson, CCLS / Lindsay Morgan, CCLS / Beth Strange, CCLS / Meg Sanders,
CCLS, Xiaomin Liang, MD
Indiana University, Riley Hospital for children

梁小民 医生
More than 4 million children need surgery in the United States
each year and it was estimated that up to 50%-75% of children
exhibit some degree of pre-operative anxiety. The experience of
anesthesia and surgery can be very stressful for many children and
their parents. Nervous children may show their anxiety in different
ways, such as frightened, agitated, trembling, too scared to speak,
stopping playing, hiding behind parents or crying.

Induction of anesthesia is considered the most stressful moment
during the whole perioperative period. Identifying children with
high risk of preoperative anxiety and treating them appropriately before surgery is very
important because, if not managed well, patients might have higher risk of developing
postoperative maladaptive behavior change or post traumatic memory, and parents might be less
satisfied as well.

The common risk factors of preoperative anxiety include patient-related (young age, poor
previous experience, shy and inhibited temperament, development delay, etc.), parent-related
(anxious parents, divorced parents, parents with multiple procedures, etc.) and environment-
related (sensory overload, conflicting messages, operating room, etc.). Among those risk factors,
the child’s age (1-5 years old) is most important. At this age, children are old enough to
recognize parental separation, but not mature enough to be cooperative due to their inability to
understand anesthesia and surgery.

Preoperative anxiety in children can be managed with pharmacologic method (like
administering versed, ketamine, or dexmedetomidine preoperatively) or non-pharmacologic
method (like psychological preparation program by using illustrated books, video programs,
puppet shows, developing coping skills with the assist of child life specialist, allowing parent
presenting to OR), or both. Among those non-pharmacologic interventions, children’s coping
skills facilitated by child life specialists are the most helpful techniques. With the assistance of
child life specialists, some children can even have MRI, radiation therapy, or some minor
procedures without anesthesia.

Child life specialists are medical professionals with expertise in child development,
therapeutic play, and the psychosocial care of children and families. They evaluate individual
psychosocial risks factors and provide case-based medical understandings, psychological
preparation, coping skills, and psychosocial support for children and their families to make their
hospital visits less stressful, less anxious.

P a g e 31 | 65