3. Identificazione dei fattori determinanti il livello di ansia
7.1 Tecniche non farmacologiche:
7.2.6 Nuovi farmaci: Melatonina
La N-acetil-5metoxitriptamina è un ormone sintetizzato, a partire dalla serotonina, nella ghiandola ipofisaria. Tra le sue numerose funzioni fisiologiche essa svolge un ruolo importante nella regolazione dei ritmi circadiani(111) e del sonno. Per tali ragioni viene spesso utilizzata per trattare l’insonnia e la sindrome della fase del sonno ritardata(106). La melatonina è efficace anche come ansiolitico come evidenziato in uno studio prospettico randomizzato a doppio cieco, effettuato su 7 gruppi di bambini tra i 2 e i 5 anni di età in cui venivano paragonati gli effetti sedativo/ansiolitici ed il comportamento postoperatorio dopo somministrazione orale di midazolam e di melatonina a dosi predefinite e differenziate in relazione al gruppo (0,1 mg-0,25 mg-0,5 mg/kg). E’emerso che tali farmaci, in dosi di 0,25-0,5 mg/kg, risultavano ugualmente efficaci nell’alleviare l’ansia da separazione e lo stress dovuto dall’applicazione della maschera faciale al momento dell’induzione(152-154). Nei bambini ai quali era stata somministrata la melatonina gli episodi di eccitazione postoperatoria al risveglio cosí come lo
sviluppo di disturbi del sonno nelle due settimane successive all’intervento, rispetto al Midazolam, erano nettamente minori.
8.CONCLUSIONI
Il periodo perioperatorio induce un notevole stress emotivo nella maggior parte degli individui. Nel bambino ciò è ancora più amplificato a causa della sua incapacità di comprendere la natura della malattia e la necessità dell’intervento chirurgico. Interventi farmacologici e comportamentali possono essere utilizzati per ridurre l’ansia nel bambino e nei genitori al fine di prevenire lo sviluppo di complicanze ansia-correlate precoci e tardive. Si comprende, quindi, come la gestione dell’ansia perioperatoria rappresenti una sfida per l’anestesista e debba essere considerata l’obbiettivo principale nell’attuale pratica medica. La relazione che si instaurerà con il bambino e i suoi genitori, il riconoscimento di fattori di rischio e l’identificazione degli “stress point” saranno elementi cardine al fine di consentire all’anestesista di scegliere e contestualizzare la strategia mirata più appropriata in una determinata situazione che promuova nel bambino un’esperienza perioperatoria positiva e non traumatizzante.
9. BIBLIOGRAFIA
1. Draskovic B, Simin JM, Kvrgic IM. Psycological aspects of pediatric anesthesia. Med Preg 2015 Jan-feb;68(1-2): 29-34.
2. Ahmed MI, Farrell MA, Parrish K, Karla A. Preoperative anxiety in children risk factors and non farmacological management. Middle East J Anesthesiol 2011 Jun;21(2):153-164.
3. Visitainer MA, Wolfer JA (1975) Psycological preparation for surgery pediatric patient: the effects on children’s and parents’ stress responses and adjustement. Pediatrics 56:187-202.
4. Squires VL (1995) Child-focused perioperative education: helping children understand and cope with surgery. Semin Perioper Nurs 4:80-87.
5. Kain Z, Mayes L, Caldwell- Andrews a, Karas D, McClain B. Preoperative anxiety, postoperative pain, and behavioural recovery in young children undergoing surgery. Pediatrics [serial on the internet]. 2006 Aug [cited 2014 Jan 14];118(2):651-8.
6. Rosenbaum A, Kain Z, LarsonnP, Lőnnqvist P. The place of premedication in pediatric practice. Pediatr Anesth [serial in internet].2009 [2014 Jan 23];19:817-28.
7. Kain Z. Psychological aspects of pediatric anesthesia. In:Motoyama E, Davis P, editors. Smith’s anestesia for infants and children. 7th ed. St Louis: Mosby , Inc;2006.p241-252.
8. Watson A, Visram A. Children’s preoperative anxiety and postoperative behaviour. Pediatr Anesth [serial on internet] 2003 [cited 2014 Jan14];13:188-204.
9. Aguilera I, Patel D, Meakin G, Masterson J. Perioperative anxiety and postoperative behavioural disturbances in children undergoing intravenous or inhalation induction of anaesthesia. Paediatr Anaesth [serial on the Internet]. 2003 [cited 2014 Jan 14];13:501-7.
10. .Draskovic B, Radovanovic D, Rakic G. Primena ondansetrona, azotnogoksidula i alfentanila u sprecavanju bola izazvanog primenom propofola. Srp Arh Cel Lek [serial on the Internet]. 2013 [cited 2014 Mar 7];141(1-2):61-5.
11. Wright K, Stewart S, Finley A, Buffett-Jerrott S. Prevention and intervention strategies to alleviate preoperative anxiety in children. Behavior Modification [serial on the Internet]. 2007 Jan [cited 2014 Jan 20];31(1):52-79.
12. Draskovic B, Stanic D, Uram-Benka A, Radojcic B, Grebeldinger S. Remifentanil and Fentanil as a part of postoperative analgesia of newborns in the intensive care unit. HealthMED [serial on the Internet]. 2010 [cited 2014 Mar 7];4(4)Suppl 1:S983-91.
13. Kotiniemi L, Ryhanen P, Moilanen I. Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children. Anaesthesia [serial on the Internet]. 1997 Apr [cited 2014 Jan 20];52:970-6.
14. Caldwell-Andrews A,. Psychological predictors of postoperative sleep in children undergoing outpatient surgery. Pediatr Anesth [serial on the Internet]. 2006 [cited 2014 Jan 20];16:144–511.
15. Stanic D, Popovic N, Draskovic B, Uram-Benka A, Katanic J, Fabri I. Cortisol and a blood sugar as a good stress indicator during general anaesthesia with different opioid analgetics in children. HealthMED [serial on the Internet]. 2010 [cited 2014 Mar 7];4(4)Suppl 1:S1020-9. 16. Draskovic B, Stanic D, Uram-Benka A, Fabri I. Stress indicators during general anesthesia with opioid analgesics in children.Turk J Med Sci [Internet]. 2014 Jan 22;Epub 2013 Dec 9.
17. Litke J, Pikulska A, Wegner T. Management of perioperative stress in children and parents. Part I--the preoperative period. Anaesthesiol Intensive Ther 2012 Jul-Sep;44(3):165-169.
18. Wright K, D., Stewart S, H., Finley G, A. Is Temperament or Behavior a better Predictor of Preoperative Anxiety in Children?. Child Health Care 2013;42(2):153-167.
19. Nasr VG, Hannallah RS. Emergence agitation in childrena view. Middle East J Anaesthesiol 2011 Jun;21(2):175-182.
20. Karimi R, Fadaiy Z, Nikbakht Nasrabadi A, Godarzi Z, Mehran A. Effectiveness of orientation tour on children's anxiety before elective surgeries. Jpn J Nurs Sci 2014 Jan;11(1):10-15.
21. Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Curr Opin Anaesthesiol 2014 Jun;27(3):309-315.
22. Brewer S, Gleditsch SL, Syblik D, Tietjens ME, Vacik HW. Pediatric anxiety: child life intervention in day surgery. J Pediatr Nurs 2006 Feb;21(1):13-22.
23. Kain ZN, Mayes LC, O’connor TZ, Cicchetti DV: Preoperative anxiety in children: Predictors and outcomes. Arch Ped Adol Med; 1996, 150(12):1238-1245.
24. McCann M, Kain Zn: “Management of Preoperative anxiety in children: an update”. Anesth Analg; 2001, 93:98-105.
25. Lee J, Lim H, Son JS, Lee JR, Kim DC, et al. Cartoon distraction alleviates anxiety in children during induction of anesthesia. Anesth Analg 2012 Nov;115(5):1168-1173.
26. Karling M. Child behaviour and pain after hospitalization, surgery and anaesthesia [dissertation]. Umeå: Umeå University;2006.
27. Kain Z, Mayes L, Caramico L. Preoperative preparation in children: a cross-sectional study. J Clin Anesth [serial on the Internet]. 1996 Sept [cited 2014 Jan 20];8:508-14.
28. Kain Z, Mayes L, Weisman S, Hofstadter. Social adaptability, cognitive abilities, and other predictors for children’s reactions to surgery. J Clin Anesth [serial on the Internet]. 2000 Nov[cited 2014 Jan 20];12:549-54.
29. Caprilli S, Cipriani A. Terapia del dolore del bambino e aspetti psicologici in chirurgia pediatrica.
30. Cagiran E, Sergin D, Deniz MN, Tanatti B, Emiroglu N, Alper I. Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children. J Int Med Res 2014 Apr;42(2):572- 580.
31. Dreger VA, Trembeck TF: Management of perioperative anxiety in children. AORN Journal;2006,84(5):788-804.
32. MacLaren JE, Thompson C, Weineberg M, et al: Prediction on perioperative anxiety in children: who is most accurate? Anesth Analg,2009,108(6):1777-82.
33. Kain ZN, Maclaren J, Mayes LC (2009) Perioperative Behavior Stress in Children. In: Cote CJ, Lerman J, and ID Todres, Eds. A Practice of Anesthesia for Infants and Children. Philadelphia, PA: Saunders Elsevier 27.
34. Turner JC (2009) Theoretical Foundation of Child Life Practice, in The Handbook of Child Life, a Guide for Pediatric Psychosocial Care. Thompson RH Editor, Springfield, Illinois: Charles Thomas 28. 35. Wollin SR, Plummer JL, Owen H, Hawkins RM, Materazzo F (2003)
Predictors of preoperative anxiety in children. Anaesth Intensive Care 31: 69-74.
36. Forsyth D (1934) Psychological effects of bodily illness in children. Lancet 227: 15-18.
37. Wright KD, Stewart SH, Finley GA, Buffett-Jerrott SE (2007): Prevention and intervention strategies to alleviate preoperative anxiety in children: a critical review. Behav Modif 31: 52-79.
38. Corman HH, Hornick EJ, Kritchman M, Terestman N (1958) Emotional reactions of surgical patients to hospitalization, anesthesia and surgery. Am J Surg 96: 646-653.
39. Yuki K, Daaboul DG. Postoperative maladaptive behavioral changes in children. Middle East J Anaesthesiol 2011 Jun;21(2):183-189. 40. Kain ZN, Mayes L, Cicchetto D et al: The Yale Preoperative Anxiety
Scale: How does it compare with a “gold standard?” Anesth Analg; 1997, 85:783-788.
41. Kain ZN: Postoperative maladaptive behavioral changes in children: Incidents, risk factors, and interventions. Acta Anesthesiol Belg; 2000, 51: 217-226.
42. Julian LJ. Measures of anxiety. HHS Public Access 2011 2011 Nov 43. Li HC, Lopez V. Effectiveness and appropriateness of therapeutic
play intervention in preparing children for surgery: a randomized controlled trial study. J Spec Pediatr Nurs 2008 Apr;13(2):63-73. 44. Tunney AM, Boore J. The effectiveness of a storybook in lessening
anxiety in children undergoing tonsillectomy and adenoidectomy in Northern Ireland. Issues Compr Pediatr Nurs 2013 Dec;36(4):319- 335.
45. Mifflin KA, Hackmann T, Chorney JM. Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia. Anesth Analg 2012 Nov;115(5):1162- 1167
46. Kerimoglu B, Neuman A, Paul J, Stefanov DG, Twersky R. Anesthesia induction using video glasses as a distraction tool for the management of preoperative anxiety in children. Anesth Analg 2013 Dec;117(6):1373-1379.
47. Hosseinpour M, Memarzadeh M. Use of a preoperative playroom to prepare children for surgemiffry. Eur J Pediatr Surg 2010 Nov;20(6):408-411.
48. Franck LS, Spencer C (2005) Informing parents about anaesthesia for children's surgery: a critical literature review. Patient Educ Couns 59: 117-125.
49. Astuto M, Rosano G, Rizzo G, Disma N, Raciti L, et al. (2006): Preoperative parental information and parents' presence at induction of anaesthesia. Minerva Anestesiol 72: 461- 65.
50. Burton L (1984) Anxiety relating to illness and treatment. In V. Verma (Ed.), Anxiety in Children (pp. 151-172). New York: Methuen Croom Helm.
51. Burkhardt U, Vetter B, Wild L, Olthoff D (1995) Plasma catecholamine level and clinical parameters--quality criteria for premedication in childhood. Anaesthesiol Reanim 20: 88-96.
52. Kiefer RT, Weindler J, Ruprecht KW (1998) The endocrine stress response after oral premedication with low-dose Midazolamfor intraocular surgery in retrobulbar anaesthesia. Eur J Ophthalmol 8:239-245.
53. Li HC, Lopez V (2006) Assessing children's emotional responses to surgery: a multidimensional approach. J Adv Nurs 53: 543-550. 54. Fortier MA, Chorney JM, Rony RY, et al: children's desire for
perioperative information. anesth analg; 2009, 109:(4):1085-1090. 55. Kain ZN, Wang SM, Caramico LA, et al: Parental desire for
perioperative information and informed consent: a two-phase study.
anesth analg; 1997, 84:299-306.
56. Iaccobucci T, Federico B, Pintus C, De Francisci G: evaluation of satisfaction level by parents and children following pediatric anesthesia. paed anaesth; 2005, 15:(4):314-320.
57. Bellew M, Atkinson Kr, Dixon G, Yates A: The introduction of a paediatric anaesthesia information leaflet: an audit of its impact on parental anxiety and satisfaction. Ped Anaesth; 2002, 12:(2):124-30. 58. . Margolis Jo, Ginsberg B, Dear Gl, Ross Ak, Goral Je, Bailey Ag:
Paediatric Preoperative teaching: effects at induction and postoperatively. Paed Anaesth; 1998, 8(1):17-23.
59. McEwen A, Moorthy C, Quantock C, Rose H, Kavanagh R. The effect of videotaped preoperative information on parental anxiety
during anesthesia induction for elective pediatric procedures. Paed Anaesth; 2007, 17:(6):534-9
60. Fincher W, Shaw J, Ramelet AS (2012) The effectiveness of a standardised preoperative preparation in reducing child and parent anxiety: a single-blind randomised controlled trial. J Clin Nurs 21: 946-955
61. He HG, Zhu L, Li HC, Wang W, VehvilÃinen JK, et al. (2014) A randomized controlled trial of the effectiveness of a therapeutic play intervention on outcomes of children undergoing inpatient elective surgery: study protocol. J Adv Nurs 70: 431-442
62. Tourigny J, Chartrand J (2009) Evaluation of a preoperative virtual tour for parents and children. Rech Soins Infirm : 52-57
63. Kain ZN, Caramico LA, Mayes LC, Genevro JL, Bornstein MH, et al.\(1998) Preoperative preparation programs in children: a comparative\examination. Anesth Analg 87: 1249-1255
64. Moadad N, Kozman K, Shahine R, Ohanian S, Badr LK (2015) Distraction Using the BUZZY for Children During an IV Insertion. J Pediatr Nurs S0882-5963(15)00239-0
65. Trottier ED, Ali S, Le May S, Gravel J (2015) Treating and Reducing Anxiety and Pain in the Paediatric Emergency Department: The TRAPPED survey. Paediatr Child Health 20: 239-244
66. Goldberger J, Gaynard L (1990) Helping children cope with health care procedures. Contemporary Pediatrics 158
67. Alessandra Codognotto. Il guanto magico. 2006; Available at: http://ipasvigorizia.it/. Accessed 09/19, 2015
68. Klassen J, Liang Y, Tjosvold L, Klassen T, Hartling L. Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials. Ambul Pediatr [serial on the Internet]. 2008 Apr [cited 2014 Jan 30];8(2):117-28
69. Kain Z, Wang S, Mayes L, Krivutza D, Teague B. Sensory stimuli and anxiety in children undergoing surgery: a randomized, controlled trial. Anesth Analg [serial on the Internet]. 2001 Apr [cited 2014 Jan 30];92:897-903
70. Kain Z, Caldwell-Andrews A, Krivutza D, Weinberg M, Gaal D, Wang S, et al. Interactive music therapy as a treatment for preoperative anxiety in children: a randomized controlled trial. Anesth Analg [serial on the Internet]. 2004 May [cited 2014 Jan 30];98:1260- 6
71. Kar SK, Ganguly T, Roy SS, Goswami A (2015) Effect of Indian Classical Music (Raga Therapy) on Fentanyl, Vecuronium, Propofol Requirements and Cortisol levels in Cardiopulmonary Bypass. J Anesth Crit Care Open Access 2: 00047
72. Golan G, Tighe P, Dobija N, Perel A, Keidan I. Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial. Paediatr Anaesth [serial on the Internet]. 2009 Mar [cited 2014 Jan 30];19(3):262-6
73. Vagnoli L, Caprilli S, Messeri A. Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option? Pediatr Anesth [serial on the Internet]. 2010 Oct [cited 2014 Jan 30];20:937-43
74. Messina M, Molinaro F, Meucci D, Angotti R, Giuntini L, Cerchia E, et al.Preoperative distraction in children: hand-held videogames vs clown therapy. Pediatr Med Chir 2014 Dec 30;36(5-6):98
75. Kuttner L. Pediatric hypnosis: pre-, peri-, and post-anesthesia. Paediatr Anaesth 2012 Jun;22(6):573-577
76. Calipel S, Lucas-Polomeni MM, Wodey E, Ecoffey C. Premedication in children: hypnosis versus Midazolam. Pediatr Anesth [serial on the Internet]. 2005 Apr [cited 2014 Jan 30]; 15:275-81
77. Wang SM, Peloquin C, Kain Z. The use of auricular acupuncture to reduce preoperative anxiety. Anesth Analg [serial on the Internet]. 2001 [cited 2014 Jan 30];93:1178-80
78. Wang SM, Maranets I, Weinberg M, Caldwell-Andrews A, Kain Z. Parental auricular acupuncture as an adjunct for parental presence during induction of anesthesia. Anesthesiology [serial on the Internet]. 2004 June [cited 2014 Jan 30];100:1399-404
79. Wang S, Gaal D, Maranets I, Caldwell-Andrews A, Kain Z. Acupressure and preoperative parental anxiety: a pilot study. Anesth Analg [serial on the Internet]. 2005 Sept [cited 2014 Jan 30];101:666- 9)
80. Patel A, Schieble T, Davidson M, Tran M, Schoenberg C, Delphin E, et al. Distraction with a hand-held video game reduces pediatric preoperative anxiety. Pediatr Anesth [serial on the Internet]. 2006 Oct [cited 2014 Jan 31];16:1019-27
81. Lee JH, Jung HK, Lee GG, Kim HY, Park SG, Woo SC. Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients. Korean J Anesthesiol [serial on the Internet]. 2013 Dec [cited 2014 Jan 31];65(6):508-18
82. Changing Healthcare Providers. Behavior during Pediatric Inductions with an Empirically Based Intervention. Martin, SR, Chorney JM, Tan ET, Fortier MA, Blount RL, Wald SH, Shapiro NL, Strom, SL, Patel S, Kain ZN. Anesthesiology; 2011; 115(1):18-27
83. Maclaren Je, Kain Zn: Development of a brief behavioral intervention for children’s anxiety at anesthesia induction. Children’s Heath Care; 2008, 37:196-209
84. Fordham La: Approach to the pediatric patient. Ultrasound Clin; 2009, 4:439-443.
85. Collarusso Ca: Psychological approach to the pediatric patient. In: Edwards DK & Hilton SVW, eds. Practical Pediatric Radiology. Philadephia, PA: Saunders Elsevier: 2006, 642
86. Dixon Sd, Stein Mt: Encounters with children: Pediatric Behavior
87. Schulman JL, Foley JM, Vernon DT, Allan D (1967) A study of the effect of the mother's presence during anesthesia induction. Pediatrics 39:111-114
88. Hannallah RS, Rosales JK (1983) Experience with parents presence during anaesthesia induction in children. Can Anaesth Soc J 30: 286- 289
89. Hickmott KC, Shaw EA, Goodyer I, Baker RD (1989) Anaesthetic induction in children: the effects of maternal presence on mood and subsequent behaviour. Eur J Anaesthesiol 6: 145-155.
90. Bevan JC, Johnston C, Haig MJ, Tousignant G (1990) Preoperative parental anxiety predicts behavioural and emotional responses to induction of anaesthesia in children. Can J Anaesth 37: 177-182. 91. Kain ZN, Mayes LC, Caramico LA, Silver D (1996) Parental
presence during induction of anesthesia. A randomized controlled trial. Anesthesiology 84: 1060-1067.
92. Kain ZN, Mayes LC, Wang SM, Caramico LA, Hofstadter MB (1998) Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective? Anesthesiology 89: 1147-1156.
93. Kain Zn, Mayes L, Caldwell-Andrews A, Saadat H, McClain B, Wang SM. Predicting which children benefit most from parental presence during induction of anesthesia. Pediatr Anesth [serial on the Internet]. 2006 Jun [cited 2014 Jan 23];16:627-34.
94. Kain Zn, Caldwell-Andrews AA, Maranets I, Nelson W, Mayes LC (2006) Predicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach. Anesth Analg 103: 81-84
95. Caldwell-Andrews AA, Kain ZN, Mayes LC, Kerns RD, Ng D (2005) Motivation and maternal presence during induction of anesthesia. Anesthesiology 103: 478-483.
96. Astuto M, Rosano G, Rizzo G, Disma N, Raciti L, Sciuto O. Preoperative parental information and parents’ presence during induction of anaesthesia. Minerva Anestesiol [serial on the Internet]. 2006 Jun [cited 2014 Jan 30];72(6):461-5.
97. Kita T, Yamamoto M (2009) Parental presence is a useful method for smooth induction of anesthesia in children: a postoperative questionnaire survey. Masui 58: 719-723.
98. Chundamala J, Wright JG, Kemp SM (2009) An evidence-based review of parental presence during anesthesia induction and parent/child anxiety. Can J Anaesth 56: 57-70.
99. Manyande A, Cyna AM, Yip P, Chooi C, Middleton P (2015) Nonpharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev 7:CD006447 100. Ryder IG, Spargo PM (1991) Parents in the anaesthetic room.
101. Braude N, Ridley SA, Sumner E (1990) Parents and paediatric anaesthesia: a prospective survey of parental attitudes to their presence at induction. Ann R Coll Surg Engl 72: 41-44.
102. Kain Zn, Caldwell-Andrews AA, Mayes LC, Wang SM, Krivutza DM, et al. (2003) Parental presence during induction of anesthesia: physiological effects on parents. Anesthesiology 98: 58-64.
103. Vessey Ja, Bogetz Ms, Caserza Cl, Liu Kr, Cassidy, Md: Parental upset associated with participation in induction of anaesthesia in children. Can J Anaesth; 1994, 41:(4):276-80.
104. Lewyn Mj: Should parents be present while their children receive anesthesia?. Anesth Malpract Protect; 1993, May, 56-57.
105. O'Sullivan M (2013) Wong GK. Preinduction techniques to relieve anxiety in children undergoing general anaesthesia. Contin Educ Anaesth Crit Care Pain 13: 196-199
106. McCann ME, Kain ZN (2001) The management of
preoperativeanxiety in children: an update. Anesth Analg 93: 98-105. 107. Stewart S, Buffett-Jerrott S, Finley A, Wright K, Valois Gomez T.
Effects of Midazolamon explicit versus implicit memory in a pediatric surgery setting. Psychopharmacology [serial on the Internet]. 2006 Apr [cited 2014 Jan 20];188:489-97.
108. McGraw T, Kendrick A. Oral Midazolampremedication and postoperative behavior in children. Paediatr Anaesth [serial on the Internet]. 1998 Mar [cited 2014 Jan 30];8:117-21.
109. Almenrader N, Passariello M, Coccetti B, Haiberger R, Pietropaoli P. Premedication in children: a comparison of oral Midazolamand oral clonidine. Pediatr Anesth [serial on the Internet]. 2007 [cited 2014 Jan 30];17:1143-9.
110. Athanassiadou, E., Tsiantis, J., Chistogiorgos, S.,Kolaitis, G. An Evaluation of the effectiveness of psychological preparation of children for minor surgery by puppet play and brief mother counseling. Psychother Psychosom 2009;78:62-63
111. Weaver DR, Stehle JH. Stopa EG, el al. Melatonln recep-tors in human hypochalamus and pituitary: implications for circadian and reproductive responses to melatonin. J Clin EndocrimlMetab 1993; 76: 295-301.
112. Short TG, Forrest P. Galletly DC. Paradoxical reactions to benzodiazepines—a genetically determined phenomenon? Anaesth Intens Care 1987; 15: 330-331.
113. Samarkandi A, Naguib M., Riad W., Thalaj A, Alotibi W., Aldammas F., Albassam A. Melatonin vs. Midazolam premedication in children:a double-blind, placebo-controlled study European Journal of Anaesthesiotogy 2005; 22: 189-196.
114. Gutstein H, Johnson K, Heard M, Gregory G. Oral ketamine preanesthetic medication in children. Anesthesiology 1992;76: 28 – 33.
115. Filatov SM, Baer GA, Rorarius G, Oikkonen M. Efficacy and safety of premedication with oral premedication for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA. Acta Anaesthesiol Scand 2000;44:118 –24.
116. Ghali AM, Mahfouz AK, Al-Bahrani M. Preanesthetic medication in children: A comparison of intranasal dexmedetomidine versus oral Midazolam. Saudi J Anaesth 2011;5:387-91
117. Golparvar M, Saghaei M, Sajedi P, Razavi Ss: Paradoxical reaction following intravenous Midazolam premedication in pediatric patients- a randomized placebo controlled trial of ketamine for rapid tranquilization. Paediatr Anaesth; 2004, 14:924-930.
118.Hollister Gr, Burn Jm: Side effects of ketamine in pediatric anesthesia. Anesth Analg; 1974, 53:264-267.
119. Bozkurt P. Premedication of the pediatric patient—anesthesia for the
uncooperative child. Curr Opin naesthesiol 2007; 20: 211–5
120. 1 Davis PJ, Tome JA, McGowan FX, et al. Preanesthetic medication with intranasal Midazolam for brief pediatric surgical procedures: effect on recovery and hospital discharge times. Anesthesiology 1995;82:2–5.
121. Griffith N, Howell S, Mason DG. Intranasal Midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intraobserver variability. Br J Anaesth 1998;81:865–9.
122. Marhofer P, Glaser C, Krenn CG, et al. Incidence of therapy of Midazolam induced hiccups in paediatric anaesthesia. Paediatr Anaesth 1999;9:295– 8.
123. Suresh S, Cohen IJ, Matuszczak M, et al. Dose ranging, safety,and efficacy of a new oral Midazolam syrup in children [abstract]. Anesthesiology 1998;89:A1313. 105:73– 8.
124. Karl HW, Rosenberger JL, Larach MG, Ruffle JM. Transmucosal administration of Midazolam for premedication of pediatric patients- comparison of the nasal and sublingual routes. Anesthesiology 1993;78:885–91.
125. Levine M, Spahr-Schopfer I, Hartley E, MacPherson B. Oral Midazolam premedication in children: the minimum time interval for separation from parents. Can J Anaesth 1993;40:726 –9.
126. Viitanen H, Annila P, Viitanen M, Tarkkila P. Premedication with Midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg 1999;89:75–9.
127. Viitanen H, Annila P, Viitanen M, Yli-Hankala A. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1–3 yr. Can J Anaesth 1999;46: 766–71.
128. Lapin S, Auden S, Goldsmith L, Reynolds A. Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane. Paediatr Anaesth 1999;9:299 –304.
129. Martlew RA, Meakin G, Wadsworth R, et al. Dose of propofol for laryngeal mask airway insertion in children: effect of premedication with midazolam. Br J Anaesth 1996;76:308 –9.
130. Bevan JC, Veall GR, Macnab AJ, et al. Midazolam premedication delays recovery after propofol without modifying involuntary movements. Anesth Analg 1997;85:50–4.
131. Kain Z, Mayes L, Caramico L, et al. Postoperative behavioural outcomes in children: effects of sedative premedication. Anesthesiology 1999;90:758–65.Kain Z, Hofstadter M, Mayes L, et al. Midazolam: effects of amnesia and anxiety in children. Anesthesiology 2000;93: 676–84. 55.
132. Funk W, Jakob W, Reidl T, Taeger K. Oral preanaesthetic medication for children: double-blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone. Br J Anaesth 2000;84:335-40.
133. Nishina K, Mikawa K, Shiga M, Obara H. Clonidine in paediatric anaesthesia. Paediatr Anaesth 1999;9:187–202.
134. Nishina K, Mikawa K, Maekawa N, et al. The efficacy of clonidine for reducing perioperative haemodynamic changes and volatile anaesthetic requirements in children. Acta Anaesthesiol Scand 1996;40:746 –51
135. Mikawa K, Nishina K, Maekawa N, et al. Oral clonidine premedication reduces postoperative pain in children. Anesth Analg 1996;82:225–30.
136. Reimer EJ, Dunn GS, Montomery CJ, et al. The effectiveness of clonidine as an analgesic in paediatric adenotonsillectomy. Can J Anaesth 1998;45:1162–7.
137. Epstein RH, Mendel HG, Witkowski TA, et al. The safety and efficacy of oral transmucosal fentanyl citrate for preoperative sedation in young children. Anesth Analg 1996;83:1200 –5.
138. Friesen RH, Lockhart CH. Oral transmucosal fentanyl citrate for