Assessing pediatric perioperative affect: A concise review of research and clinically relevant scales

Paediatr Anaesth. 2023 Mar;33(3):243-249. doi: 10.1111/pan.14568. Epub 2022 Oct 8.


Perioperative anxiety and distress are common in pediatric patients undergoing general anesthesia and increase the risk for immediate and long-term postoperative complications. This concise review outlines key research and clinically-relevant scales that measure pediatric perioperative affect. Strengths and weaknesses of each scale are highlighted. A literature review identified 11 articles with the following inclusion criteria: patients less than or equal to 18 years, perioperative anxiety or distress, and original studies with reliability or validity data. Although robust research-based assessment tools to measure anxiety have been developed, such as the Modified Yale Preoperative Anxiety Scale, they are too complex and time-consuming to complete by clinicians also providing anesthesia. Clinically-based anxiety measurement scales tend to be easier to use, however they require further testing before widespread standard utilization. The HRAD ± scale (Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation) may be a promising observational anxiety scale that is efficient and includes an assessment of compliance. Further studies are needed to refine a clinically-relevant anxiety assessment tool and appraise interventions that reduce perioperative distress.

Keywords: anesthesiology; anxiety; anxiety disorders; child; perioperative care; psychometrics.

Publication types

  • Review

MeSH terms

  • Anesthesia, General
  • Anxiety* / diagnosis
  • Child
  • Child Behavior
  • Emotions*
  • Humans
  • Reproducibility of Results