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Anesth Analg. 2009 Sep;109(3):737-44. doi: 10.1213/ane.0b013e3181af00e4.

The perioperative validity of the visual analog anxiety scale in children: a discriminant and useful instrument in routine clinical practice to optimize postoperative pain management.

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Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.



Because children's anxiety influences pain perception, perioperative anxiety should be evaluated in clinical practice with a unique, useful, and valid tool to optimize pain management. In this study, we evaluated psychometric properties of the visual analog scale (VAS)-anxiety for children and to study its perioperative relevance in clinical practice.


One hundred children scheduled for elective surgery and general anesthesia were included. VAS-anxiety was measured at four timepoints and compared with both versions of State Spielbergers' questionnaires (State-Trait Anxiety Inventory for Youth [STAIY] and State-Trait Anxiety Inventory for Children [STAIC]) and the modified Yale Preoperative Anxiety Scale. Children's pain, parents' anxiety, and parents' proxy report of children's anxiety were evaluated using VAS.


The correlation between STAIC and VAS-anxiety was significant on the day of discharge. Moreover, changes over time were not significant with STAIC, whereas VAS-anxiety was significantly sensitive to changes over time in the two groups of age (7-11 yr and 12-16 yr). A receiver operating characteristic curve, using modified Yale Preoperative Anxiety Scale as reference, determined a VAS-anxiety cutoff at 30 to identify high-anxiety groups. Pain levels were significantly higher when children were anxious (VAS > or = 30) in the postoperative period. Moreover, children's anxiety and pain were higher when parents were anxious.


VAS-anxiety is a useful and valid tool to assess perioperative anxiety in children aged 7-16 yr. The influence of children's and parents' anxiety on children's postoperative pain suggests that VAS-anxiety should be recommended routinely for postoperative clinical practice to optimize anxiety and pain management.

[Indexed for MEDLINE]

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