Cerrahi Sürecinde Olan Çocuk ve Ergenlerde Konsültasyon-Liyezon Psikiyatrisi
Özet
Bu bölüm, cerrahi süreçten geçen çocuk ve ergenlerde Konsültasyon Liyezon Psikiyatrisi uygulamalarını ele alıyor.
Özetle: Cerrahi işlemler, çocuk ve aileler için stresli bir deneyim olabilir. Çocukların yaşlarına ve bilişsel gelişim seviyelerine uygun destek sağlanmalıdır. 0-2 yaş grubu çocuklar bakım verenlerine bağımlıyken, 2-7 yaş grubunda büyüsel düşünme yaygındır. 7-11 yaş döneminde ise mantıksal düşünce gelişirken, ergenler ise bağımsızlık kaybı ve estetik kaygılar yaşayabilir. Nörogelişimsel bozukluğu olan çocukların cerrahi süreci daha karmaşıktır ve özel yaklaşımlar gerektirir. Ayrıca, ebeveynlerin kaygıları da çocuğun psikolojik durumunu etkileyebilir. Preoperatif hazırlık, çocukların ve ailelerin bilgilendirilmesini ve kaygının yönetilmesini içerir. Anksiyolitik premedikasyon, çocukların cerrahi öncesi rahatlatılmasını amaçlar. Bazı özel cerrahi durumlar (sünnet, ampütasyon gibi) çocuklarda psikolojik etkiler yaratabilir. Özellikle sünnetin yanlış yaşta yapılması kastrasyon anksiyetesi doğurabilir. Ampütasyon, beden imajı ve psikolojik uyum açısından önemli zorluklar yaratır. Psikiyatrik ilaç tedavisinin cerrahi süreçte nasıl yönetileceği de detaylandırılmıştır. Ayrıca, ağrı yönetimi ve pediatrik deliryum gibi durumların nasıl ele alınması gerektiği açıklanmıştır.
Özetle, çocukların cerrahi süreci psikolojik olarak sağlıklı yönetildiğinde, hem çocuk hem de aile için daha az travmatik hale gelebilir.
Preoperative preparation, Anxiolytic premedication, Circumcision / Castration anxiety, Amputation / Body image This chapter focuses on Consultation-Liaison Psychiatry practices for children and adolescents undergoing surgical procedures.
In summary: Surgical procedures can be a stressful experience for both children and their families. Support should be tailored to children's age and cognitive development level. Children aged 0-2 are highly dependent on their caregivers, while those aged 2-7 tend to engage in magical thinking. In the 7-11 age group, logical reasoning starts to develop, whereas adolescents may experience concerns related to loss of independence and cosmetic outcomes. Children with neurodevelopmental disorders require a more complex approach during surgical processes. Additionally, parental anxiety can significantly impact a child psychological state. Preoperative preparation involves informing children and their families and managing anxiety. Anxiolytic premedication aims to help children feel more at ease before surgery. Certain specific surgical conditions (such as circumcision and amputation) can have psychological effects on children. Circumcision performed at an inappropriate age may lead to castration anxiety. Amputation can present challenges related to body image and psychological adaptation. The document also details how psychiatric medication should be managed during the surgical process. Furthermore, it explains approaches to pain management and pediatric delirium.
In summary, when the surgical process is managed with psychological support, it can be less traumatic for both the child and their family.
Referanslar
Ünver S, Yildirim M. Cerrahi girişim sürecinde çocuk hastaya yaklaşım. Güncel Pediatri. 2013;11:128-133. https://doi.org/10.4274/Jcp.11.35229
Harris TB, Sibley A, Rodriguez C, et al. Teaching the psychosocial aspects of pediatric surgery. Seminars in Pediatric Surgery. 2013;22(3):161-166. doi: 10.1053/j.sempedsurg.2013.05.005
Kain ZN, Caldwell-Andrews AA, Mayes LC, et al. Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial. Anesthesiology. 2007;106(1):65-74. doi: 10.1097/00000542-200701000-00013.
Panella JJ. Preoperative care of children: Strategies from a child life perspective. Association of Operating Room Nurses journal. 2016;104(1):11-22. doi: 10.1016/j.aorn.2016.05.004.
Bibace R, Walsh ME. Development of children's concepts of illness. Pediatrics. 1980;66(6):912–917.
Cimete G, Kuğuoğlu S, Dede Çınar N. Çocuk, hastalık ve hastane ortamı. In: Conk Z, Başbakkal Z, Bal Yılmaz H, et al (eds.) Pediatri Hemşireliği. Ankara: Akademisyen Tıp Kitabevi; 2018. p.101–160.
Justus R, Wyles D, Wilson J, et al. Preparing children and families for surgery: Mount Sinai's multidisciplinary perspective. Pediatric Nursing. 2006;32(1):35-43.
Marin AM. Concepts of illness among children of different ethnicities, socioeconomic backgrounds, and genders [dissertation]. Sciences; 2011.
Johnson NL, Rodriguez D. Children with autism spectrum disorder at a pediatric hospital: A systematic review of the literature. Pediatric Nursing. 2013;39(3):131-141.
Vlassakova BG, Emmanouil DE. Perioperative considerations in children with autism spectrum disorder. Current Opinion in Anaesthesiology. 2016;29(3):359–366. doi: 10.1097/ACO.0000000000000325
Scarpinato N, Bradley J, Kurbjun K, et al. Caring for the child with an autism spectrum disorder in the acute care setting. Journal for Specialists in Pediatric Nursing. 2010;15(3):244-254. doi: 10.1111/j.1744-6155.2010.00244.x
Alpert O, Iqbal I, Andrade G, et al. Perioperative psychiatric conditions and their treatment in children and adolescents. In: Zimbrean P, Oldham M (eds). Perioperative Psychiatry: A Guide to Behavioral Healthcare for the Surgical Patient. New York (NY): Springer; 2019. p.265–287.
Gürol A, Binici Y. Günübirlik cerrahi geçirecek çocukların annelerinin anksiyete düzeyleri ve etkileyen faktörlerin belirlenmesi. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi. 2017;7(1):29-38. doi:10.5222/buchd.2017.029
Sadhasivam S, Cohen LL, Szabova A, et al. Real-time assessment of perioperative behaviors and prediction of perioperative outcomes. Anesthesia and Analgesia. 2009;108(3):822–826. doi: 10.1213/ane.0b013e318195c115.
Yılmaz E. Cerrahi süreç: Ameliyat öncesi hazırlık ve bakım. In: Aslan FE (ed.) Cerrahi Bakım: Vaka Analizleri ile Birlikte. Ankara: Akademisyen Tıp Kitabevi; 2009. p.319-346.
Beeby DG, Hughes JM. Behaviour of unsedated children in the anaesthetic room. British journal of anaesthesia. 1980;52(3):279-281. doi: 10.1093/bja/52.3.279.
Corman HH, Hornick EJ, Kritchman M, et al. Emotional reactions of surgical patients to hospitalization, anesthesia and surgery. American Journal of Surgery. 1958;96(5):646–653. doi: 10.1016/0002-9610(58)90466-5.
Kain ZN, Caldwell-Andrews AA. Preoperative psychological preparation of the child for surgery: an update. Anesthesiology Clinics of North America. 2005;23(4):597–614. doi: 10.1016/j.atc.2005.07.003.
Kain ZN, Caldwell-Andrews AA, Maranets I, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesthesia and Analgesia. 2004;99(6):1648-1654. doi: 10.1213/01.ANE.0000136471.36680.97.
Güzel ZB. Pediatrik yaş grubu hastalarında genel anestezinin perioperatif davranış ve duygudurum üzerine etkileri [Uzmanlık tezi]. Kırıkkale: Kırıkkale Üniversitesi; 2017.
UpToDate. Midazolam Pediatric Drug Information. Sedation, anxiolysis, and amnesia prior to procedure or before induction of anesthesia. 2023.
UpToDate. Lorazepam Pediatric Drug Information. Procedural Sedation. 2023.
UpToDate. Diazepam Pediatric Drug Information. Sedation, anxiolysis, and amnesia prior to procedure. 2023.
UpToDate. Ketamine Pediatric Drug Information. Procedural Sedation/Analgesia. 2023.
UpToDate. Clonidine Pediatric Drug Information. ICU sedation. 2023.
UpToDate. Dexmedetomidine Pediatric Drug Information. Sedation/Anesthesia Noninvasive Procedures. 2023.
Heikal S, Stuart G. Anxiolytic premedication for children. British Journal of Anaesthesia Education. 2020;20(7):220-225. doi: 10.1016/j.bjae.2020.02.006
Wollin SR, Plummer JL, Owen H, et al. Anxiety in children having elective surgery. Journal of Pediatric Nursing. 2004;19(2):128–132. doi: 10.1016/s0882-5963(03)00146-5
Bahadır Ö, Kürtüncü M. Müzik terapinin 6–12 yaş arası öğrenciler ve ağrı yönetimi etkisi: Randomize kontrollü bir çalışma. Ege Üniversitesi Hemşirelik Fakültesi Dergisi. 2020;36(3):175-188.
Stephens B, Barkey M. Positioning for Comfort. Bethesda (MD): Association for the Care of Children’s Health; 1994.
Başkaya M. Çocuklarda kan alma işlemi öncesi işleme hazırlamaya yönelik izletilen çizgi filmin korku ve ağrıya etkisi [Yüksek lisans tezi]. Eskişehir: Eskişehir Osmangazi Üniversitesi Sağlık Bilimleri Enstitüsü; 2018.
Karakul A, Bolışık ZB. Ameliyat sonrası iyileşme döneminde dinlenen müziğin çocuk ve ergenlerin anksiyete durumu ve yaşamsal bulguları üzerine etkisi. Pediatrik Araştırma Dergisi. 2018;5(2):82.
Hong-Gu H, Lixia Z, Wai-Chi CS, et al. Therapeutic play intervention on children's perioperative anxiety, negative emotional manifestation and postoperative pain: a randomized controlled trial. Journal of Advanced Nursing. 2015;71(5):1032-1043. doi: 10.1111/jan.12608.
Del Castillo BT, Torres JAP, Sánchez LM, et al. Reducing the pain in invasive procedures during paediatric hospital admissions: fiction, reality or virtual reality. Anales de Pediatría (English Edition). 2019;91(2):80-87. doi: 10.1016/j.anpedi.2018.10.019
Breiner SM. Preparation of the pediatric patient for invasive procedures. Journal of Infusion Nursing. 2009;32(5):252–256. doi: 10.1097/NAN.0b013e3181b42d482
Morris BJ, Wamai RG, Henebeng EB, et al. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr. 2016;14:4. doi: 10.1186/s12963-016-0073-5
American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics. 2012;130:585-6.
Weiss HA, Larke N, Halperin D, et al. Complications of circumcision in male neonates, infants and children: a systematic review. BioMed Central urology. 2010;10:2. doi: 10.1186/1471-2490-10-2.
Many BT, Rizeq YK, Vacek J, et al. A contemporary snapshot of circumcision in US children's hospitals. Journal of Pediatric Surgery. 2020;55(6):1134-1138. doi: 10.1016/j.jpedsurg.2020.02.031
Sahin F, Beyazova U, Aktürk A. Attitudes and practices regarding circumcision in Turkey. Child: Care, Health and Development. 2003;29(4):275-280. doi: 10.1046/j.1365-2214.2003.00342.x.
Öztürk MO, Uluşahin NA. Ruh Sağlığı ve Bozuklukları. 16. Baskı. Ankara: Bayt Yayınevi; 2020.
Yilmaz E, Batislam E, Basar MM, et al. Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids. International Journal of Urology: Official Journal of the Japanese Urological Association. 2003;10(12):651-656. doi: 10.1046/j.1442-2042.2003.00722.x
Rızalar S, Büyük ET, Yıldırım N. Children's perspectives on the medical and cultural aspects of circumcision. Iranian Journal of Pediatrics. 2016;27(2):e7561. doi:10.5812/ijp.7561
Bulut M, Alemdar DK, Bulut A, et al. The effect of music therapy, hand massage, and kaleidoscope usage on postoperative nausea and vomiting, pain, fear, and stress in children: A randomized controlled trial. Journal of Perianesthesia Nursing. 2020;35(6):649-657. doi:10.1016/j.jopan.2020.03.013
Ayan G, Şahin ÖÖ. Effect of therapeutic play based training program on pre- and post-operative anxiety and fear: A study on circumcision surgery in Turkish Muslim children. Journal of Pediatric Urology. 2023;19(4):431.e1-431.e9 doi: 10.1016/j.jpurol.2023.04.032.
Pazarcıkçı F, Efe E. Effects of comfort-oriented nursing care based on the comfort theory on perioperative anxiety and fear in children undergoing surgical circumcision: RCT. Journal of Perianesthesia Nursing. 2023;38(2):236-245. doi: 10.1016/j.jopan.2022.04.016
Baby S, Chaudhury S, Walia TS. Evaluation of treatment of psychiatric morbidity among limb amputees. Industrial Psychiatry Journal. 2018;27(2):240–248. doi: 10.4103/ipj.ipj_69_18.
Cheung E, Alvaro R, Colotla VA. Psychological distress in workers with traumatic upper or lower-limb amputations following industrial injuries. Rehabilitation Psychology. 2003;48(2):109-112. https://doi.org/10.1037/0090-5550.48.2.109
Ramirez C, Menaker J. Traumatic amputations. Trauma Reports. 2017;18:40-48.
Jo SH, Kang SH, Seo WS, et al. Psychiatric understanding and treatment of patients with amputations. Yeungnam University journal of medicine. 2021;38(3):194-201. doi: 10.12701/yujm.2021.00990
Kingdon D, Pearce T. Psychological assessment and management of amputee. In: Banarjee S. (ed.). Rehabilitation of Management of the Amputees. Baltimore (MD): Williams & Wilkins; 1982. p.350-371.
Block WE, Ventur PA. A study of the psychoanalytic concept of castration anxiety in symbolically castrated amputees. Psychiatric Quarterly. 1963;37:518–526.
Goldberg RT. New trends in the rehabilitation of lower extremity amputees. Rehabilitation Literature. 1984;45(1-2):2–11.
Desmond DM, Coffey L, Gallagher P, et al. Limb amputation. In: Kennedy P,(ed.). The Oxford Handbook of Rehabilitation Psychology. New York: Oxford University Press; 2012. p.351–367.
McDonald S, Sharpe L, Blaszczynski A. The psychosocial impact associated with diabetes-related amputation. Diabetic medicine : a journal of the British Diabetic Association. 2014;31(11):1424–1430. doi: 10.1111/dme.12474
Bateup M. Spiritual grief and loss after an amputation. Aboriginal and Islander Health Worker Journal. 2010;34(4):20–22.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington (DC): American Psychiatric Publishing; 2013.
Atala KD, Carter BD. Pediatric limb amputation: Aspects of coping and psychotherapeutic intervention. Child psychiatry and human development. 1992;23:117-130. doi: 10.1007/BF00709754.
Tebbi CK, Mallon JC. Long-term psychosocial outcome among cancer amputees in adolescence and early adulthood. Journal of Psychosocial Oncology. 1987;5(4):69-82. https://doi.org/10.1300/J077v05n04_06
Kelham RL. Some thoughts on mental effects of amputation. British Medical Journal. 1958;1(5066):334-337. doi: 10.1136/bmj.1.5066.334
Pamela G. Forducey, William D. Ruwe, Kawaljeet Kaur. Psychological consequences of amputation. In: Carroll K, Edelstein JE, editors. Prosthetics and patient management: A comprehensive clinical approach. Thorofare (NJ): Slack Incorporated; 2006. p. 65–75.
Ülger Ö, Topuz S, Bayramlar K, et al. Edinsel ve konjenital çocuk amputelerde fonksiyonel durumun belirlenmesi. Fizyoterapi Rehabilitasyon. 2007;18(3):187-193.
Tyc VL. Psychosocial adaptation of children and adolescents with limb deficiencies: A review. Clinical Psychology Review. 1992;12(3):275-291. https://doi.org/10.1016/0272-7358(92)90138-X
Trigo Blanco P, Oprea AD. Anesthesia: implications for psychopharmacologic treatment. In: Zimbrean P, Oldham M, (eds.) Perioperative Psychiatry: A Guide to Behavioral Healthcare for the Surgical Patient. New York (NY): Springer; 2019. p.51-64.
Attri JP, Bala N, Chatrath V. Psychiatric patient and anaesthesia. Indian Journal of Anaesthesia. 2012;56(1):8-13. doi: 10.4103/0019-5049.93337
UpToDate. Perioperative medication management. 2023.
Sadana N, Joshi GP. Pharmacology and perioperative considerations for psychiatric medications. Current Clinical Pharmacology 2017;12(3):169–175. doi:10.2174/1574884712666170823121850.
Bakır E. Çocuklarda ağrı değerlendirme ve ölçekleri: Kültür ve yaşın ağrı değerlendirmesine etkileri. Turkiye Klinikleri Journal of Nursing Sciences. 2017;9(4):299-314. doi: 10.5336/nurses.2016-52467
Chou R, Gordon DB, de Leon-Casasola OA, et al. Guidelines on the management of postoperative pain. Journal of Pain. 2016;7:131-157.
Okyay RD, Ayoğlu H. Çocuklarda postoperatif ağrı yönetimi. Pediatric Practice and Research. 2018;6(2):16-25. https://doi.org/10.21765/pprjournal.414257
Dechnik A, Traube C. Delirium in hospitalised children. Lancet Child Adolescent Health. 2020 Apr;4(4):312–321. doi:10.1016/S2352-4642(19)30377-3.
Van Tuijl SCL, van Cauteren TJM, Pikhard T, et al. Management of pediatric delirium in critical illness: a practical update. Minerva anestesiologica. 2015;81(3):333-341.
Grover S, Ghosh A, Kate N, et al. Do motor subtypes of delirium in child and adolescent have a different clinical and phenomenological profile? General hospital psychiatry. 2014;36(2):187-191. doi: 10.1016/j.genhosppsych.2013.10.005.
Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Critical Care. 2008;12 Suppl 3:S3. doi: 10.1186/cc6149
Thom RP. Pediatric delirium. American Journal of Psychiatry Residents' Journal. 2017:12(2):6-8. https://doi.org/10.1176/appi.ajp-rj.2017.12020
UpToDate. Haloperidol Pediatric Drug Information, Delirium critical care setting. 2023.
UpToDate. Risperidone Pediatric Drug Information, Delirium. 2023.
UpToDate. Olanzapine Pediatric Drug Information, Delirium. 2023.
UpToDate. Quetiapine Pediatric Drug Information, Delirium ICU setting. 2023.
