Pediatrics
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Randomized Controlled Trial Clinical Trial
Psychological preparation for surgery pediatric patients: the effects on children's and parents' stress responses and adjustment.
This clinical experiment tested variations of psychological preparation and supportive care designed to increase the adjustment of children (and their parents) hospitalized for elective surgery. Eighty-four children, aged 3 to 12, admitted for tonsillectomies were randomly assigned to one of three treatment conditions or to a control group: (1) a combination of systematic preparation, rehearsal, and supportive care conducted prior to each stressful procedure; (2) a single-session preparation conducted after admission, and (3) consistent supportive care given by one nurse at the same points as in the first condition, but including no systematic preparation or rehearsal. The children's hospital adjustment was measured by blind ratings of behavioral upset and cooperation during the blood test, medication injection, transport to surgery, induction, and postoperative fluid intake and by recovery room medications and pulse rates and time to first voiding. ⋯ Parent outcome measures included self-ratings for anxiety and satisfaction with information and care. As hypothesized, the results demonstrated that children who received condition one showed significantly less upset and more cooperation and their parents reported significantly greater satisfaction and less anxiety than did children or parents in the other groups. Younger children were significantly more upset and less cooperative than older children.
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In order to decrease complications of improper endotracheal tube positioning, a method of placing the tube by palpation within the suprasternal notch was devised. The method proved to be simple and effective. The accuracy was verified by fluoroscopy and a clinical study comparing this technique with others is reported. ⋯ This point allows for movement of the tube tip with head positioning and of the carina with respiration. The tube tip can be placed near the IMP by the suprasternal palpation technique. This method, therefore, is useful in emergency situations or on initial intubations to avoid improper position of the tube tip prior to radiograph verification.