Pediatric: Preoperative anxiety

Advanced, Pediatrics

Who is at greatest risk?

Why treat it?

5 factors that provoke anxiety:

Pharmacologic Management -Route given : oral > nasal> IM > rectal Medication % usage/ route options & dose:

Midazolam (85%)

PO (0.5 mg/kg), nasal/sublingual (0.2–0.3 mg/kg), rectal (0.5-1 mg/kg)

Ketamine (4%)

PO (5-6 mg/kg), IM (2-5 mg/kg), nasal(3-5 mg/kg), rectal (5-6 mg/kg)

Fentanyl (3%)

PO (10–15 mcg/kg), IV (2 mcg/kg)

Dexmedetomidine (?)

Nasal (3 mcg/kg), IV (0.5-1 mcg/kg)

Clonidine (?) PO (4-6 mcg/kg)

Non-Pharmacologic Management Parental presence

  • Pros: Avoids the need for pre-operative sedatives, avoid separation anxiety
  • Cons: Adverse parental reaction and litigation if injury ensues, anxious parents, stress on anesthesiologist/OR staff, less effective than Midazolam

Child life

Work with children pre-op to reduce incidence of anxiety

Pre-op programs

Give parents and children an idea of what to expect on the day of surgery and reduce anxiety


    J Dev Behav Pediatr;1990 Feb;11(1):13-6

    [PubMed: 2303552]

    J Pediatr Nurs;1997 Aug;12(4):252-5

    [PubMed: 9271886]

    Arch Pediatr Adolesc Med. 1996 Dec;150(12):1234-5

    [PubMed: 8953995]

    Anesth Analg;2001 Jul;93(1):98-105

    [PubMed: 11429348]

    Pediatrics;1975 Aug;56(2):187-202

    [PubMed: 1161368]


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Catherine Ray, MD