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INTRODUCTION: Anxiety in children triggered by a scheduled surgical intervention is a major issue due to its frequency and consequences. Preoperative anxiety is associated with increased patient fear and agitation on anesthetic induction. The aim of this study is to compare three preoperative anxiety scales for children undergoing elective outpatient surgery, and to correlate each of these tools with the degree of patient compliance on induction, as assessed by the Induction Compliance Checklist (ICC). METHODS: An observational prospective study was performed on a cohort of children with ages between 2 and 16 years old, scheduled for outpatient surgery. Anxiety was assessed upon arrival to the hospital (M0), during transfer to the surgical unit (M1), and in the operating room during anesthetic induction (M2). Anxiety in the parents (measured with the State-Trait Anxiety Inventory, STAI) and in the children (measured with the Spence Anxiety Scale-Pediatric, SCAS-P, the State-Trait Anxiety Inventory Children, STAIC, and Modified Yale Preoperative Anxiety Scale, m-YPAS) was assessed. Compliance with anesthetic induction was assessed with ICC. RESULTS: The study included 76 patients (72.4% male, median age 7.9 years). Anxiety scores (m-YPAS) increased as the moment of surgery approached, being greater at the entrance to the surgical unit (M0 = 26.1 ± 9.5; M1 = 31.8 ± 18.1; M2 = 33.5 ± 21.1). A strong correlation was found between ICC scale and m-YPAS at M1 (0.738) and M2 timepoints (0.794), but not with the rest of scales at M0. CONCLUSIONS: Standard anxiety assessment scales do not predict the quality of anesthetic induction. m-YPAS scale can detect increasing anxiety in children as they approach the surgical procedure and this correlates strongly with a worse anesthetic induction, defined by higher score on ICC scale.
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BACKGROUND AND OBJECTIVE: Congenital structural hemoglobinopathies are a group of disorders whose incidence has experienced an increase in recent years, due to the higher number of immigrants living in the Region of Madrid. Given the possibility of starting early prophylactic measures, it seems advisable to carry out an screening of hemoglobinopathies in this region. The objective of this work was to know the current incidence of hemoglobinopathies in the Hospital Clinico San Carlos and to analyze the more suitable laboratory diagnostic tests. SUBJECTS AND METHOD: An ambispective cohort study, with 3,365 newborns studied at the Hospital Clinico San Carlos from May 2003 to June 2004. All were studied by cation exchange HPLC [Variant (Bio-Rad)] and pathologic specimens were analyzed by reversed phase HPLC. RESULTS: Hemoglobinophaty was detected in 26 children with the HPLC Variant, with a global incidence of 7.7 per 1,000 newborns: 1 case of sickle cell disease, 18 cases of sickle cell trait, 1 HbC, 1 HbE/A2 and five indeterminate cases. CONCLUSIONS: Neonatal screening for hemoglobinopathies in the Region of Madrid is necessary, and the HPLC Variant is an appropriate technique.
Assuntos
Hemoglobinopatias/diagnóstico , Triagem Neonatal , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , EspanhaRESUMO
Fundamento y objetivo: Las hemoglobinopatías estructurales son un grupo de enfermedades cuya incidencia en la Comunidad de Madrid ha aumentado en los últimos años debido al creciente fenómeno de la inmigración que está viviendo. Dados los problemas de morbimortalidad que comportan y la posibilidad de instaurar tratamientos profilácticos tempranos, consideramos necesario realizar un estudio que demuestre la necesidad de la inclusión del cribado de hemoglobinopatías en dicha comunidad autónoma. Sujetos y método: Estudio de cohortes ambispectivo en 3.365 recién nacidos realizado en el Hospital Clínico San Carlos desde mayo de 2003 a abril de 2004. Todas las muestras se analizaron mediante cromatografía líquida de alta resolución (HPLC) de intercambio iónico (Variant®, Bio-Rad) y en las patológicas se estudiaron las cadenas de globina mediante HPLC de fase reversa. Resultados: Se encontró una incidencia global de hemoglobinopatías de 7,7 de cada 1.000 recién nacidos, con un caso de hemoglobina S homocigota, 18 de hemoglobina S heterocigota, uno de hemoglobina E/A2, uno de hemoglobina C y 5 picos anómalos. Conclusiones: Consideramos que el cribado neonatal de hemoglobinopatías en la Comunidad de Madrid es necesario y que la HPLC de intercambio iónico Variant® es adecuada para el cribado de las hemoglobinopatías más frecuentes, con ahorro de tiempo
Background and objective: Congenital structural hemoglobinopathies are a group of disorders whose incidence has experienced an increase in recent years, due to the higher number of immigrants living in the Region of Madrid. Given the possibility of starting early prophylactic measures, it seems advisable to carry out an screening of hemoglobinopathies in this region. The objective of this work was to know the current incidence of hemoglobinopathies in the Hospital Clinico San Carlos and to analyze the more suitable laboratory diagnostic tests. Subjects and method: An ambispective cohort study, with 3,365 newborns studied at the Hospital Clinico San Carlos from May 2003 to June 2004. All were studied by cation exchange HPLC [VariantTM (Bio-Rad)] and pathologic specimens were analyzed by reversed phase HPLC. Results: Hemoglobinophaty was detected in 26 children with the HPLC Variant, with a global incidence of 7.7 per 1,000 newborns: 1 case of sickle cell disease, 18 cases of sickle cell trait, 1 HbC, 1 HbE/A2 and five indeterminate cases. Conclusions: Neonatal screening for hemoglobinopathies in the Region of Madrid is necessary, and the HPLC VariantTM is an appropriate technique
