Assessing children's emotional responses to surgery: a multidimensional approach

Aims. This paper reports a study to assess the interrelationships between physiological measures of children's heart rates and blood pressure, subjective measures of children's level of anxiety, and direct behavioural observations in children's emotional responses to surgery. Background. Psychological upset has been described as a multidimensional phenomenon which includes behavioural, subjective, and physiological components. However, a majority of previous studies have employed only one or two measures of psychological upset. Most importantly, the interrelationships among these three components of psychological upset have seldom been explored. Methods. A cross-sectional design was employed, and 106 Chinese children admitted for day surgery during the summer of 2004 were invited to participate in the study. They were asked to respond to the Chinese version of the State Anxiety Scale for Children. Their mean arterial blood pressure and heart rates were recorded in the operating theatre after being transferred to the operating table but before anaesthesia induction. A research nurse used the Children's Emotional Manifestation Scale to document the children's emotional behaviours during anaesthesia induction. The data were collected in 2004. Results. Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction. Those with more negative emotional behaviour or high levels of state anxiety also had faster heart rates and higher mean arterial blood pressure. Conclusion. A child's response to stressful medical procedures can be varied. The emotional responses of children to surgery need to be understood as a multidimensional phenomenon. To gain a more comprehensive understanding of the effects of surgery on children, it is recommended that assessment strategies used should reflect the multidimensional phenomenon of the emotional upset.