Development of Evidence-Based Clinical Practice Guidelines for Pediatric Preoperative Anxiety

Preoperative anxiety is a problem that occurs frequently in pediatric patients. Preoperative anxiety creates physical and psychological changes that impact a child’s surgical experience. Pediatric patients who experience preoperative anxiety may also experience prolonged postoperative care, long-term psychological complications, and increased postoperative pain. Sedating medications are often administered to prevent and treat preoperative anxiety. Commonly, midazolam is administered intranasally to prevent preoperative anxiety. Midazolam increases the risk of cognitive impairment and respiratory depression. Dexmedetomidine is an effective alternative to midazolam. Dexmedetomidine is a highly selective alpha-2 agonist and provides arousable sedation without respiratory depression. Dexmedetomidine is safe and effective at decreasing modified Yale Preoperative Anxiety Scale (m-YPAS) scores, improving mask acceptance, and easing child-parent separation. Many hospitals lack evidence-based guidelines for preventing perioperative anxiety. This evidence-based practice project analyzes current literature to implement into practice for assessing and preventing preoperative anxiety. The Iowa Model guides the implementation of this evidence-based practice project. This project provides evidence-based guidelines for preoperative anxiety in pediatric patients in an outpatient surgery center in an urban midwestern community.