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RESUMO

A anestesia, a cirurgia e o internamento hospitalar so acontecimentos de vida

stressantes podendo desencadear medo e ansiedade nas crianas e pais com

repercusses negativas em vrias reas de desenvolvimento e prolongando-se no

tempo. No presente estudo procuramos avaliar, em crianas com idades entre os 7-10

anos, a existncia de consequncias, a curto (peri e 1 ms ps), mdio (2 meses) e

longo prazos (3 meses), do confronto com os stressores anestsico, cirrgico e de

internamento, isolados ou acumulados, sobre reas cognitivas, comportamentais e

rendimento escolar. A amostra foi constituda por um total de 100 crianas, sendo 75

acometidas a quatro grupos experimentais: um grupo submetido a anestesia geral,

cirurgia minore internamento (n=26); um grupo submetido a anestesia geral e cirurgiaminor em regime ambulatrio (n=19); um grupo submetido a anestesia geral para

exames invasivos (n=15) e um grupo submetido s a internamento (n=15) e as

restantes 25 crianas constituram o grupo de controlo. Os grupos experimentais foram

avaliados nos momentos peri e 1, 2 e 3 meses ps confronto em termos de reas

cognitivas e comportamentais e rendimento escolar e o grupo de controlo foi avaliado

num nico momento temporal, sendo a ansiedade das mes e crianas avaliada no

momento peri confronto. Os dados foram tratados com base na anlise das

percentagens de casos situados acima de um ponto de corte clinicamente significativoe com base nos ranks mdios de cada grupo. Os resultados obtidos vo no sentido

dos grupos submetidos a internamento apresentarem percentagens mais elevadas e

com maior durao de casos com significado clnico em problemas comportamentais.

Os grupos sem internamento apresentam maiores percentagens de queixas

somticas, com aumento a partir dos 2 meses. As reas cognitivas no aparecem

grandemente afectadas para nenhum dos grupos e a ansiedade estado das mes

aparece afectada para todos os grupos experimentais. As comparaes intergrupos

com base nos ranks mdios, so menos claras em termos de diferenciao dos

grupos. So discutidas as implicaes dos resultados em termos de prtica clnica e

contributos para o corpo de conhecimentos actuais sobre o tema.

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ABSTRACT

Anesthesia, surgery and hospitalization are stressful life events that may contribute to

fear and anxiety reactions in children and parents that may reverberate on negative

outcomes in various developmental areas and extend beyond the medical encounter.

The present study tried to assess, in 7 to 10 year old children, the existence of short

(peri and post 1 month), medium (post 2 months) and long (post 3 months) term effects

of anesthetic, surgical and hospitalization stressors, either isolated or cumulative, upon

cognitive, behavioral and achievment in academic areas. Our sample had 100 children

75 were commited to four experimental groups: the first one submited to general

anesthesia, minor surgery and short term hospitalization (n=26); the second one

submited to general anesthesia and minor surgery on a day care basis (n=19); the third

one submitted to general anesthesia for obtrusive examinations and the fourth one

submitted to hospitalization alone. The remaining 25 children were the control group.

Children in the experimental groups were assessed just before the medical encounter

in the areas of cognition, behaviour and academic achievment and the control group

was assessed just once in time, being that mothersand children anxiety were

assessed for all groups on the first moment. The collected data were studied, based on

the percentages of cases beyond or behind a clinical cut off point and on mean ranks

obtained for each group. Our results showed a tendency towards higher percentages ofclinical significant cases with extended lenght of time in the hospitalizad groups in

behavioural problems. Non hospitalized groups showed higher percentages on somatic

complains, with hightened values from 2 months on.. Cognitive and academic

achievment areas did not show affection in none of the groups and mothers state

anxiety was affected in all experimental groups. Between group comparisons based on

mean ranks are less clear differentating between groups. We discuss the implications

of our findings in terms of clinical practice and their contribution for the investigation on

this theme.

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RSUM

Lanesthsie, la chirurgie et lhospitalisation sont des vnements de vie stressants qui

peuvent contribuer aux reactions de crainte et danxiet chez les enfants et les parents

et qui peuvent rverbrer sur des rsultats negatifes dans divers secteurs

developpementaux et se prolonger au-del de la rencontre mdicale. Cette tude a

essay devaluer, dans des enfants de 7 10 ans, lexistance deffects court (peri et

post 1 mois), moyen (post 2 mois) et long (post 3 mois) terme, des stresseurs

anesthsique, chirurgique et dhospitalisation, isols ou cumulatifs, sur les secteurs

cognitives, comportamentalles et scolaire. Notre chantillon a eu 100 enfants, 75

taient assaillis quatre groupes experimentaux : le premier soumis lanesthsie

gnerale, la chirurgie mineure et lhospitalisation court terme (n=26); le second

soumis lanesthsie gnerale et la chirurgie mineure sur une base de garde (n=19);

le troisime soumis lanesthsie gnerale pour des examens (n=15); le quatrime

soumis lhospitalization (n=15). Les 25 enfants restants taient le groupe de controle.

Les enfants dans les groupes experimentaux ont t valus juste avant le rencontre

mdicale et 1, 2 et 3 mois aprs, dans des secteurs cognitifes, comportamentales et

scolaires et le groupe controle a t valu seulement une fois. Lanxiet des mres et

des enfants a t value pour tous les groupes le premier moment. Nos donnes on

t tudies bas sur les pourcentages des cas au del ou derrire un point de coupeclinique et sur les rangs moyens obtenus pour chaque groupe. Nos donnes on montr

une tendance vers des pourcentages plus levs de cas avec de la signification

clinique et se prolongeant dans le temps dans les groupes hospitaliss, dans des

problmes comportamentaux. Les groupes non hospitaliss on montr des

pourcentages plus levs de cas dans plaints somatiques, avec des valeurs plus

levs partir de 2 mois. Les secteurs cognitife et scolaire nont pas montr tre

afects pour quelqun des groupes et lanxiet situationale des mres a t affecte

dans tous les groupes experimentales. Les comparaisons entre les groupes bases

dans les rangues moyens, ont t moin claires dans la differentiation des groupes.

Nous discutons les implications de nos rsultats pour la pratique clinique et leur

contribution pour la recherche.