Pediatric Surgery

RESEARCH FINDINGS USING GUIDED IMAGERY FOR

SURGERY FOR CHILDREN AND ADOLESCENTS

August, 2006

Scope of the Issue

There were 2,310,000,in-hospital surgeries (DeFrances & Podgornik, 2006) and 2,318,000 out-patient surgeries (Hall and Lawrence, 1998) performed on children under the age of 15 in the years 2004 and 1996 respectively.

Children and Surgery

Children have a kaleidoscope of fears around surgery. Some of these fears are of mutilation, needles, loss of control, pain, the unknown, separation from family and friends, and fear of the unfamiliar staff, routines, and equipment in the hospital (Petrillo & Sanger, 1983; Timmerman, 1983).

Their anxiety can increase their pain and slow their recovery. It can also lead to lack of cooperation with staff. Surgery can also cause regressive behavior, including nightmares, bedwetting, and acting out behaviors that can last for months; this can be a significant problem for families (Bar-Mor, 1997). With over 4 million pediatric surgeries per year, speeding recovery even slightly could provide significant savings.

Research in Mind/Body Interventions

Pre-operative preparation for pediatric surgical patients has been found helpful in improving children’s following instructions in the hospital. It can also reduce problems at home after the surgery (Bar-More, 1997; O-Connor-von, 2000). Reducing children’s anxiety, and increasing their sense of control is also beneficial – leading to shorter hospital stays, shorter procedure time, and less need for some medications (Butler & Simons, 2005; Lambert, 1996; Jones, 1979.

Surgical prep programs have also been found to increase patient satisfaction with the surgical experience (Brewer and Lausat, 1997). Surgical preparation with guided imagery has been found to reduce pain and anxiety, and accelerate recovery in adult surgical patients. Tusek, Church and Fazio (1997) studied 130 patients undergoing abdominal surgery for colorectal disorders.

The imagery group needed significantly less pain medication, had faster return of bowel function, and reported less pain and anxiety. Daake and Gueldner (1989) found that patients who participated in guided imagery pre-operatively had less need for pain medication post-operatively, and Holden-Lund (1988) documented faster wound healing in patients who relaxed with guided imagery.

Clinical studies have also shown that patients who use relaxation and guided imagery have fewer complications, reduced bleeding, are more comfortable after surgery, and spend less time in the hospital (Tuset, Church, and Fazio).

Mind-body studies have also been done involving the pediatric population. Distraction using a video game reduced children’s anxiety both before surgery and during administration of anesthesia (Patel, Schieble, et al, 2006). Jones (1979) used hypnosis/imagery in addition to general anesthesia in children undergoing spinal surgery. The imagery group needed less chemical anesthesia. Lambert (1996) studied 52 children undergoing a variety of surgeries. Those who received guided imagery/hypnosis pre-operatively had shorter hospital stays and reported less pain.

Guided imagery/self-hypnosis has been shown to help children tolerate procedures (including needle sticks) with less need for sedation, and less pain and anxiety. Olness (1981) successfully used imagery with 25 pediatric cancer patients who tolerated procedures including bone marrow aspiration, lumbar puncture, and chemotherapy with less pain and nausea than a control group.

Hypnosis and cognitive behavioral therapy were both successful in lowering children’s pain and anxiety, with hypnosis being the more successful of the two in relieving their anxiety (Liosi & Hatira, 1999). A guided imagery tape enabled children undergoing MRI to remain still and avoid sedation (Smart, 1997). In children undergoing repeat voiding cystourethrography, the children using hypnosis reported less distress, the parents reported that the procedure was less traumatic, and medical staff reported greater ease of conducting the procedure, as well as shorter procedural duration (Butler & Symons, 2005).

While larger, better designed studies are required, two reviews of the medical literature acknowledged the potential of hypnosis in reducing pain and distress during pediatric oncology procedures (Richardson, Smith, et al, 2006; Wild, Espie, 2004).

Conclusion

Guided imagery is an effective way to help pediatric patients and families cope with the stress of surgery and hospitalization, cooperate with invasive procedures, and speed readiness for discharge from hospital.

REFERENCES

Bar-Mor G. Preparation of Children for Surgery and Invasive Procedures: Milestones on the Way to Success. Journal of Pediatric Nursing. 1997 12(4) 252-255.

Butler LD, Symons BK, Henderson SL, Shortliffe LD, Spiegel D. Hypnosis reduces distress and duration of an invasive medical procedure for children. Pediatrics. 2005 Jan;115(1):e77-85.

DeFrances CJ, Podgornik M. 2004 National Hospital Discharge Survey. Advance data from National Vital and Health Statistics; no. 371. 2006 Hyattsville, Maryland: National Center for Health Statistics. Table 8, pg. 20.
http://www.cdc.gov/nchs/data/ad/ad371.pdf
Accessed August, 2006.

Hall MJ, Lawrence L. Ambulatory Surgery in the United States, 1996. Advance Data from National Vital and Health Statistics; no. 300. Table 4, pg. 7. 1998 http://www.cdc.gov/nchs/data/ad/ad300.pdf.
Accessed August, 2006.

Brewer SL, Lausat CS. Preparing Children for Same Day Surgery – Innovative Approaches. Journal of Pediatric Nursing. 1997 12(4) 257-9.

Daake DA, Gueldner SH. Imagery, instruction and the control of post surgical pain. Applied Nursing Research. 1989 2 114-120.

Holden-Lund C. Effects of relaxation with guided imagery on surgical stress and wound healing. Research in Nursing and Health. 1988 11 Aug. 235-244.

Jones CW. Hypnosis and spinal fusion by Harrington instrumentation. Am. Journal of Clinical Hypnosis 1979 19 155-57.

Lambert S. The Effects of Hypnosis/Guided Imagery on the Postoperative Course of Children. Developmental and Behavioral Pediatrics. 1996 17 (5) 307-310.

Liossi C, Hatira P. Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations. Int J Clin xp Hypn. 1999 Apr;47(2):104-16.

O-Connor-Von S. Preparing Children for Surgery – an integrative research review. AORN Journal. 2000 71(2) 334-43.

Olness K. Imagery (self-hypnosis) as adjunct therapy in childhood cancer. Am. Journal of Pediatric Hematology/Oncology. 1981 3 (3) 313-320.

Patel A, Schieble T, Davidson M, Tran MC, Schoenberg C, Delphin E, Bennett H. Distraction with a hand-held video game reduces pediatric preoperative anxiety. Paediatr Anaesth. 2006 Oct;16(10):1019-27.

Petrillo M, Sanger, S. Emotional Care of Hospitalized Children 2nd edition. J.B. Lippincott. 1983

Richardson J, Smith JE, McCall G, Pilkington K. Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions. J Pain Symptom Manage. 2006 Jan;31(1):70-84.

Smart G. Helping children relax during magnetic resonance imaging. MCN Am J Matern Child Nurs. 1997 Sept-Oct;22(5):236-41.

Timmerman RR. Preoperative fears of older children. AORN Journal, 1983 Nov;38(5) 827-831.

Tusek D, Church J, Fazio V. Guided Imagery as a Coping Strategy for Perioperative Patients. AORN Journal. 1997 66;(4) 644-649.

Wild MR, Espie CA. The efficacy of hypnosis in the reduction of procedural pain and distress in pediatric oncology: a systematic review. J Dev Behav Pediatr. 2004 Jun;25(3):207-13.