A shortened, modified version of the modified Yale Preoperative Anxiety Scale is described. (Image source: Thinkstock)

A shortened, modified version of the modified Yale Preoperative Anxiety Scale is described. (Image source: Thinkstock)

Preoperative anxiety has been extensively studied in the anesthesia literature.  Preoperative anxiety is associated with adverse outcomes in children such as nightmares, separation anxiety, and increased analgesic requirements postoperatively, and thus assessment and treatment are important components of optimum anesthesia care.  The Yale Preoperative Anxiety Scale was developed almost twenty years ago and has become one of the main tools used to measure preoperative anxiety in children. A modified version has been used for the last 15 years in over 100 studies to assess child anxiety during the induction of anesthesia.

The modified Yale Preoperative Anxiety Scale (mYPAS) is comprised of five items: activity, vocalizations, emotional expressivity, state of apparent arousal, and use of parent. Each item is scored on a one to four point scale except for the “vocalizations” item, which is scored on a one to six point scale. It is intended for use at four specific perioperative time points: in the preoperative holding area, during the walk to the operating room, at the entrance to the operating room, and during introduction to the anesthesia mask. The scale can be somewhat burdensome to use due its length and the need for multiple administrations.

In this month’s edition of Anesthesia & Analgesia, Dr. Michelle A. Fortier, Department of Anesthesiology & Perioperative Care, University of California, Irvine, Irvine, California, and colleagues describe the analysis used to develop a shorter, modified version of this tool in their article titled “Development of a Short Version of the Modified Yale Preoperative Anxiety Scale.”

The study authors used statistical analysis of data collected during prior studies that utilized the mYPAS.  They were able to reduce the scale to four items: activity, vocalizations, emotional expressivity, and state of apparent arousal while still maintaining strong internal reliability, interrater reliability, and convergent validity.  The “use of parent” item was eliminated due to both content overlap with other items and because parents were not always present for that item to be scored.

The requirement for assessment at four time points is also burdensome. Statistical analysis by the authors showed that the scale can retain its accuracy even if it’s only administered at two time points: in the preoperative holding area and when the anesthesia mask is introduced to the child. Abbreviating the scale in this manner allows it to be more conveniently used in future studies of perioperative anxiety.

Decreasing preoperative anxiety remains a priority in our specialty. We turn to novel drugs, such as dexmedetomidine, and distracting behaviors, such as iPad surfing, to alleviate preoperative anxiety. An abbreviated version of the mYPAS will help us effectively monitor the utility of strategies to reduce preoperative anxiety.