Avaliação dos níveis de estresse em crianças submetidas a procedimentos cirúrgicos dosados pelo cortisol salivar
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Data
2021-08-30
Autores
Silveira, Ketillyn Nayara de Macedo
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: a hospitalização cirúrgica é um fator de grande estresse para as crianças e os pais, pois implica na mudança das rotinas diárias e medo dos procedimentos invasivos e dolorosos. O estresse eleva os níveis de ansiedade influenciando nas funções normais do corpo, afetando o sistema nervoso, endócrino e imune. Objetivo: comparar o nível de estresse e ansiedade em crianças, acompanhadas ou não por seus responsáveis, submetidas a procedimentos cirúrgicos por meio da dosagem de amostras do cortisol salivar e aplicação da escala EAPY-m, assim como dos responsáveis, presentes ou não, no momento da indução anestésica por meio da dosagem de amostras do cortisol salivar e aplicação da escala HADS. Métodos: o estudo contemplou crianças em idade pré-escolar e escolar, Estado Físico I, II e III, acompanhadas por responsável legal, de ambos os sexos, submetidas a procedimentos cirúrgicos eletivos. Foram excluídas do estudo crianças que receberam medicação pré-anestésica, uso crônico de corticosteroide, com necessidade de suporte ventilatório mecânico e o responsável ter se alimentado com menos de uma hora para a coleta de saliva e uso de corticosteroide e medicamento antidepressivo. As crianças foram divididas em dois grupos: Grupo Acompanhadas e grupo Não acompanhadas, assim como os seus responsáveis. Foi aplicado o questionário de ansiedade pré-operatória de Yale modificado (EAPY-m) para as crianças e Escala hospitalar de ansiedade e depressão (HADS) para os responsáveis além da coleta de amostras de saliva para dosagem do cortisol em ambos os grupos. Resultados: participaram do estudo 42 crianças com seus responsáveis, sendo que 64% da amostra foram crianças do sexo masculino, em idade pré-escolar (75%) e ASA I. As crianças estavam acompanhadas majoritariamente por suas mães (80%). As crianças do grupo Acompanhadas apresentaram um escore de ansiedade (50±18) e os responsáveis do grupo Não acompanhadas um escore de ansiedade (10±4). Não houve diferença estatística significativa para os valores do cortisol salivar para ambos os grupos. Em torno de 70% dos responsáveis respondeu que se sentiu muito angustiado com o processo anestésico cirúrgico da criança. Conclusão: não houve diferença da dosagem do cortisol salivar entre os grupos de crianças e responsáveis. A ansiedade determinada pela escala EAPY-m foi maior nas crianças que estavam no grupo Acompanhadas, assim como para os responsáveis.
Introduction: Surgical hospitalization is a factor of great stress for children and parents, because it implies the change of daily routines and fear of invasive and painful procedures. Stress raises anxiety levels, influencing the body's normal functions, affecting the nervous, endocrine and immune systems. Objective: To compare the level of stress and anxiety in children, with or without their parents, submitted to surgical procedures through the dosage of salivary cortisol samples and application of the EAPY-m scale, as well as the level of stress and anxiety in children, with or without their parents, at the time of induction of anesthesia through the dosage of salivary cortisol samples and application of the HADS scale. Methods: The study included preschool and school children, physical status I, II, and III, accompanied by a legal guardian of both genders undergoing elective surgical procedures. Children who received pre-anesthetic medication, chronic use of corticosteroids, needed mechanical ventilatory support and the person responsible had been feeding for less than 1 hour for saliva collection and use of corticosteroid and antidepressant medication were excluded from the study. The children were divided into two groups, followed group and not followed group, as well as their caretakers. The modified Yale preoperative anxiety questionnaire (EAPY- m) was applied to the children and the Hospital Anxiety and Depression Scale (HADs) to the guardians, and saliva samples were collected for cortisol dosage in both groups. Results: Forty-two children and their caretakers participated in the study; 64% of the sample was male, preschool age (75%), and ASA I. The children were accompanied mostly by their caretakers. The children were mostly accompanied by their mothers (80%). The children in the accompanied group had an anxiety score (50±18) and the caregivers in the unaccompanied group had an anxiety score (10±4). There was no statistically significant difference for salivary cortisol values for both groups. Around 70% of the caretakers answered that they felt very anxious during the child's anesthesia. Conclusion: There was no difference in salivary cortisol levels between the groups of children and caretakers. Anxiety determined by the EAPY-m scale was higher in children who were in the monitored group, as well as for the caregivers.
Introduction: Surgical hospitalization is a factor of great stress for children and parents, because it implies the change of daily routines and fear of invasive and painful procedures. Stress raises anxiety levels, influencing the body's normal functions, affecting the nervous, endocrine and immune systems. Objective: To compare the level of stress and anxiety in children, with or without their parents, submitted to surgical procedures through the dosage of salivary cortisol samples and application of the EAPY-m scale, as well as the level of stress and anxiety in children, with or without their parents, at the time of induction of anesthesia through the dosage of salivary cortisol samples and application of the HADS scale. Methods: The study included preschool and school children, physical status I, II, and III, accompanied by a legal guardian of both genders undergoing elective surgical procedures. Children who received pre-anesthetic medication, chronic use of corticosteroids, needed mechanical ventilatory support and the person responsible had been feeding for less than 1 hour for saliva collection and use of corticosteroid and antidepressant medication were excluded from the study. The children were divided into two groups, followed group and not followed group, as well as their caretakers. The modified Yale preoperative anxiety questionnaire (EAPY- m) was applied to the children and the Hospital Anxiety and Depression Scale (HADs) to the guardians, and saliva samples were collected for cortisol dosage in both groups. Results: Forty-two children and their caretakers participated in the study; 64% of the sample was male, preschool age (75%), and ASA I. The children were accompanied mostly by their caretakers. The children were mostly accompanied by their mothers (80%). The children in the accompanied group had an anxiety score (50±18) and the caregivers in the unaccompanied group had an anxiety score (10±4). There was no statistically significant difference for salivary cortisol values for both groups. Around 70% of the caretakers answered that they felt very anxious during the child's anesthesia. Conclusion: There was no difference in salivary cortisol levels between the groups of children and caretakers. Anxiety determined by the EAPY-m scale was higher in children who were in the monitored group, as well as for the caregivers.
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Palavras-chave
Cortisol, Ansiedade, Procedimentos cirúrgicos, Anestesia, Criança, Anxiety, Surgical procedures, Anesthesia