Preoperative Anxiety Management Practices in Pediatric Anesthesia: A Comparative Analysis of an Online Survey presented to Experts and Social Media Users (Preprint)

Abstract

Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological interventions and non-pharmacological interventions are used to reduce children’s anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. As a consequence, many different approaches exist.

To increase understanding of the current anxiety management practices, we conducted a public survey via social media platforms, aiming to compare anesthesia providers from an “expert” group and a “social media” group in terms of pediatric anesthesia expertise and to identify differences in preoperative anxiety management between the two groups.

Two surveys were conducted: The first survey targeted attendees of the Scientific Working Group on Pediatric Anesthesia in June 2023 forming the ‘Expert Group’ (EG), and the second survey targeted followers of a pediatric anesthesia platform on social media forming the ‘Social Media Group’ (SG). Both surveys with 24 items were conducted using the same online platform. Questions were grouped into five categories: Pediatric Anesthesia Expertise, Representativity, Structural Conditions, Practices of Pharmacological Management and Practices in Non-Pharmacological Management. The primary objective was to assess the pediatric anesthesia expertise of the SG compared to the EG. Secondary objectives were the differences in the clustered categories with regards to preoperative anxiety management.

The study included 198 respondents, with 194 analyzed after excluding 4 due to prior participation or missing data (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs. 10 years, p<0.001), higher specialist status (97.6% vs. 64.6%, p<0.001), and a greater pediatric anesthesia volume (43.9% vs. 12.0% with more than 500 cases per year, p<0.001). Regarding the representativity, two items out of four were statistically significant (level of care of institution, annual case load of institution). Regarding the overall anxiety management practices used, there is a heterogeneous response pattern within both groups, with only five out of 17 items showing statistical significance (feasibility of parental presence during induction, known anxiety measurement tools, induction-based prescription of drugs, minimum age and use of non-pharmacological interventions).

Although the respondents do not reflect the level of expertise as a survey of a scientific working group, social media surveys on pediatric anesthesia may be feasible to get an overview of a specific topic when there is great heterogeneity overall. In our case, both cohorts showed little difference in the management of preoperative anxiety in daily practice with very heterogeneous approaches. Evidence-based recommendations could help to standardize preoperative anxiety management and improve anxiety levels in children.

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