OBJECTIVE. Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children. METHODS. We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy. Before surgery, we assessed child and parental situational anxiety and temperament. After surgery, all subjects were admitted to a research unit in which postoperative pain and analgesic consumption were assessed every 3 hours. After 24 hours in the hospital, children were discharged and followed up at home for the next 14 days. Pain management at home was standardized. RESULTS. Parental assessment of pain in their child showed that anxious children experienced significantly more pain both during the hospital stay and over the first 3 days at home. During home recovery, anxious children also consumed, on average, significantly more codeine and acetaminophen compared with the children who were not anxious. Anxious children also had a higher incidence of emergence delirium compared with the children who were not anxious (9.7% vs 1.5%) and had a higher incidence of postoperative anxiety and sleep problems. CONCLUSIONS. Preoperative anxiety in young children undergoing surgery is associated with a more painful postoperative recovery and a higher incidence of sleep and other problems.

Preoperative Anxiety, Postoperative Pain, and Behavioral Recovery in Young Children Undergoing Surgery

Three modes of resistance to persuasion (biased assimilation, relative weighting of attributes, and minimization of impact) were examined in the context of a longitudinal field study of the Clinton-Lewinsky affair and a lab experiment in the consumer setting. Only two of these modes (biased assimilation and relative weighting) were found to be sensitive to the refutability of the persuasive communication; the effectiveness of the remaining one (minimization of impact) was not influenced by this factor. Specifically, committed individuals demonstrated biased assimilation in the face of easy to refute negative information, but this mode of resistance decreased in its effectiveness when the information became difficult to refute. The relative-weighting mode of resistance (decreasing the weight given to attributes influenced by the negative information and increasing the weight given to favorably evaluated attributes), in contrast, emerged only in the face of difficult to refute information, apparently when biased assimilation decreased in its effectiveness. The impact mode of resistance was fairly effective in the face of both easy and difficult to refute information. That is, committed respondents attempted to isolate the impact of the negative information to the target attribute, minimizing its spillover to the other attributes in the attitudinal representation in response to both easy and difficult to refute messages.

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Examination of psychological processes underlying resistance to persuasion

This study investigated subjects' cognitive, affective, and physiological reactions to equity and inequity. Results confirmed two hypotheses derived from equity theory: (a) Subjects were more content (and less distressed) when they were equitably rewarded than when they were either underrewarded or overrewarded (Hypothesis 1). Further, overrewarded subjects were more content than were underrcwardcd subjects (Hypothesis 2). Hypothesis 3 predicted that when persons are led to expect inequity, they will be less distressed when an injustice is actually encountered than they would be had they been unprepared for the inequity. This hypothesis was also supported. This last finding was explained in terms of the notion of cognitive set, as developed by Austin.

Reactions to confirmations and disconfirmations of expectancies of equity and inequity

This study attempted to predict postoperative pain from preoperative level of anxiety and the amount of information patients possessed regarding their surgery. Pain was assessed via the McGill Pain Questionnaire (MPQ) and a measure of pain complaints--number of analgesics taken. High levels of state anxiety and a high degree of information predicted the Present Pain Intensity measured of the MPQ, but did not predict the Pain Rating Index portion of the MPQ. The number of analgesics taken was predicted from the amount of information but not the level of presurgical anxiety. Biographical variables were unrelated to postoperative pain. The results were discussed in terms of State-Trait Anxiety theory, Janis' curvilinear prediction model and a contextual perspective of information imparting.

Preoperative predictors of postoperative pain

Elective surgery patients were prepared for surgery with training in muscle relaxation or with information about sensations they would experience. Relaxation reduced hospital stay, pain, and medication for pain and increased strength, energy, and postoperative epinephrine levels. Information reduced hospital stay. Personality variables (denial, fear, aggressiveness) were associated with recovery and influenced patients' responses to preparation. Less frightened patients benefited more from relaxation than did very frightened patients. Nonaggressive patients reacted to information with decreased hospital stay along with increased pain, medication, and epinephrine. Aggressive patients responded to information with decreased hospital stay along with decreased pain, medication, and epinephrine. Patients using denial were not harmed by preparation. A catharsis/moderation model is proposed to explain how information benefits patients. An active coping model is proposed to explain the benefits of relaxation. This study suggests that behavioral preparation benefits even frightened, aggressive, or denying elective surgical patients.

Behavioral preparation for surgery: Benefit or harm?

This impressive book deals with a relatively neglected subject which is of importance from the point of view both of its theoretical significance for the behavioral sciences and of its practical implications for alleviating the emotional suffering attendant upon physical suffering. While the book reports the results of research on the psychological reactions of surgical patients, the author approaches his subject matter with some years of experience in disaster research and laboratory studies of stress behind him, and places the subject sturdily within a general theoretical perspective of stress as a universal human experience. The author's propositions, thus, are couched in abstract terms applicable: to generalization to other stress situations. Although specific descriptive material, and practical suggestions for preparing surgical patients, are included in the text, the author clearly is most concerned with making a contribution to a general theory of stress behavior. In addition to the ambitiousness of the

Rue Bucher

Papers

Psychological Stress: Psychoanalytic and Behavioral Studies of Surgical Patients.