Manejo de la ansiedad preoperatoria en pacientes pediátricos en Colombia

Abstract

Antecedentes La ansiedad perioperatoria se asocia con desenlaces postoperatorios negativos, especialmente en poblaciones susceptibles como los niños. La ansiolisis perioperatoria permite atenuar esos efectos, sin embargo, las características de su práctica son desconocidas en Colombia. Objetivo Describir los factores relacionados con la práctica de ansiolisis perioperatoria en población pediátrica, llevada a cabo por anestesiólogos en Colombia. Materiales y métodos Se trata de un estudio descriptivo. mediante encuestas electrónicas auto diligenciadas se exploraron variables demográficas, conocimientos, actitudes y prácticas sobre el manejo y la prevención de la ansiedad perioperatoria en niños. Se excluyeron registros incompletos para el análisis de variables asociadas y se realizó un análisis de sensibilidad para determinar el impacto de la exclusión de respuestas incompletas en los resultados. El envío de las encuestas estuvo a cargo de la Sociedad Colombiana de Anestesiología. Resultados Se obtuvieron 220 encuestas completas, en su mayoría de Bogotá, Valle del Cauca y Antioquia. La prevalencia de ansiolisis perioperatoria fue de 86,8%, su práctica no se relacionó con la presencia de formación de subespecialidad. Limitantes como “Falta de fomento institucional” (p0,001 OR=1,69), “No disponibilidad de fármacos ansiolíticos ideales” (p=0,000 OR=3,52) y “Temor a los eventos adversos asociados con algunos fármacos ansiolíticos” (p=0,013 OR=5,47) se relacionaron con la no realización de ansiolisis perioperatoria en niños. Así mismo, un menor puntaje Conclusión Existen diferentes factores, que limitan la realización de ansiolisis perioperatoria en niños, potencialmente modificables con políticas nacionales, institucionales y profesionales.

Abstract: Background Anxiety represents an emotional phenomenon, which carries substantial neurobiological changes in those who experience it. This response is enhanced in special populations, as children, in whom different factors interact to make of anxiety a disgusting and detrimental experience for homeostatic functions. Several authors, have described the pathogenic potential of this state, including perioperative period, where anxiety carries negative postoperative outcomes. Perioperative anxiety, may diminish that effect, however, the characteristics of its practice were unknown in Colombia. Aim To describe factors related with perioperative ansiolisis in pediatric populations, carried out by Colombian anesthesiologists. Methods a descriptive study was performed, sending an online survey to 2549 anesthesiologists, registered in the Colombian Society of Anesthesiology (SCARE, from its name in Spanish) database. Twenty-four variables were explored regarding anesthesiologists’ perceptions, attitudes and knowledge about management and prevention of perioperative anxiety in children. Only full records were included in the final analysis and an additional sensitivity analysis was made in order to determine the impact that exclusion of incomplete surveys had in the results. Results From 296 records, 220 were complete surveys, the relation between male:female was of 2:1, more than 50% of the answers came from Bogotá, Valle del Cauca and Antioquia. Less than 30% of the anesthesiologists reported subspecialty formation, however, this condition was not related with the practice of perioperative ansiolisis in children, which had a prevalence of 86.8% from the total of surveys gathered. In multivariate analysis, the variables related with not-using perioperative ansiolisis strategies were, “Lack of institutional promotion” (p=0.000 OR=1.69), “Unavailability of ideal anxiolytic medicines” (p=0.000 OR=3.52) and “Fear of drug-related adverse reactions” (p=0.013 OR=5.47). Conclusion Institutional programmes that promote perioperative ansiolisis in children, inclusion of oral and rectal route anxiolytic medications and creation of minimum security standards in terms of pediatric perioperative ansiolisis by national scientific societies to promote prevention and management of perioperative anxiety in children, are needed.