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BACKGROUND The numbers of people requiring total arthroplasty is expected to increase substantially over the next two decades. However, increasing costs and new payment models in the USA have created a sustainability gap. Ad hoc interventions have reported marginal cost reduction, but it has become clear that sustainability lies only in complete(More)
OBJECTIVE To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery. DESIGN A prospective, longitudinal study. SETTING A university children's hospital. PARTICIPANTS One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery. MAIN(More)
BACKGROUND Children and parents experience significant anxiety and distress during the preoperative period. Currently available interventions are having limited efficacy. Based on an integration of the literature in both the anesthesia and psychological milieus, the authors developed a behaviorally oriented perioperative preparation program for children(More)
UNLABELLED In this study, we examined whether interactive music therapy is an effective treatment for preinduction anxiety. Children undergoing outpatient surgery were randomized to 3 groups: interactive music therapy (n = 51), oral midazolam (n = 34), or control (n = 38). The primary outcome of the study was children's perioperative anxiety. We found that(More)
Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O(More)
BACKGROUND Both midazolam and parental presence during induction of anesthesia are routinely used to treat preoperative anxiety in children. The purpose of this investigation was to determine which of these two interventions is more effective. METHODS Anxiety of the child during the perioperative period was the primary end point. Secondary end points(More)
BACKGROUND The minimum time interval between administration of oral midazolam and separation of children from their parents that ensures good anterograde amnesia has not been previously determined. This is of particular importance in a busy operating room setting where schedule delays secondary to midazolam administration may not be tolerated. METHODS(More)
UNLABELLED Evaluating the effectiveness of interventions directed toward the treatment of preoperative anxiety in children has been hindered by the absence of a statistically valid measurement tool. In a previous investigation, we developed an instrument (Yale Preoperative Anxiety Scale [YPAS]) that can be used to assess anxiety in children undergoing(More)
BACKGROUND A significant number of children undergoing anesthesia and surgery exhibit new-onset sleep-related problems postoperatively. The aim of this longitudinal cohort study was to expand previous research in this area by using a new objective technology. METHODS This study compared children undergoing general anesthesia and outpatient surgery (n =(More)
BACKGROUND How phenylephrine and ephedrine treatments affect global and regional haemodynamics is of major clinical relevance. Cerebral tissue oxygen saturation (Sct(O2) )-guided management may improve postoperative outcome. The physiological variables responsible for Sct(O2) changes induced by phenylephrine and ephedrine bolus treatment in anaesthetized(More)