الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
INTRODUCTION
The perioperative period is often an extremely traumatic time for the young child undergoing surgery. Up to 65% of all children undergoing anesthesia and surgery develop intense anxiety and fear in the preoperative holding area and during induction of anesthesia. (1) This anxiety is characterized by subjective feelings of tension, apprehension, nervousness, and worry that may appear in various forms.
Some children verbalize their fears, whereas for others, anxiety is expressed only behaviorally. Many children look scared, become agitated, breathe deeply, tremble, stop talking or playing, and may start to cry. Others may unexpectedly urinate, have increased motor tone, and may actively attempt to escape from the medical personnel.
These reactions reflect the child’s fear of separation from parents and home environment, uncertainty about the anesthesia, surgery, and outcome of the operation, as well as of loss of control, unfamiliar routines, surgical instruments, and hospital procedures. Several studies have indicated, based on both behavioral and physiological responses, that induction of anesthesia appears to be the most stressful procedure the child experiences during the preoperative period. (2)
One of the most commonly performed surgeries in preschool children is superficial inguinal surgery.
Superficial Inguinal Surgery
It is a surgery involving structures related to the anterior abdominal wall in the inguinal region of which the most important is the inguinal canal.
Superficial inguinal surgery is considered as a day-case surgery. A day-case surgery is defined as planned investigations or procedures on patients who are admitted and discharged home on the day of their surgery but require some facilities and time for recovery. Minor procedures in out-patient or accident and emergency departments are not included. In most countries, this means that the patient spends a few hours in hospital and does not stay overnight. However, in the USA, day surgery is termed ’ambulatory surgery’ and includes patients who may spend up to 23 hours in hospital, allowing a greater range of procedures to be included.
The impetus for this has been the high cost of keeping patients in in-patient beds, the reduction in availability of these beds and long surgical waiting lists in publicly funded healthcare systems. Patients, particularly children, benefit from reduced stays in hospital and a rapid return to their home environment, provided that their surgery is uncomplicated and without significant pain or nausea. (3) Superficial inguinal lesions in children requiring ambulatory surgery include the following:
a) Congenital inguinal hernia;
b) Congenital hydrocele;
c) Palpable undescended testicle;
d) Skin lesions (e.g. lipoma) in the inguinal region.