Evaluation of anxiety before and after bronchoscopy in hospitalized children undergoing bronchoscopy

Introduction: Flexible fiberoptic bronchoscopy is a safe, minimally invasive procedure with minor complications that can be applied in children and allows direct monitoring and evaluation of the nose, larynx, pharynx and tracheobronchial tree with a flexible device with a camera at the tip. During the procedure, dynamic changes such as mucosal features, lumen shape and diameter of the airlines, as well as glottis movements, are also monitored. The process can be recorded with video and re-evaluated. Flexible bronchoscopy has indications for diagnostic, therapeutic and airway management. Bronchoalveolar lavage (BAL) performed by bronchoscopy can obtain representative samples from the distal airways and alveolar surfaces and provide information about infectious and/or inflammatory processes. Although there are no definitive contraindications for this procedure, resistant pulmonary hypertension, hypoxemia, and uncorrected bleeding diathesis can be considered relative contraindications. Careful analysis of the indications and clinical condition for the patient, monitoring with appropriate anesthesia during the procedure ensures that the procedure is successful with minimal complications. Adequate preparation before the procedure and performing the procedure by experienced teams are very important for the procedure to be completed safely. Flexible bronchoscopy is performed under general anesthesia in the operating room with a team consisting of a pediatric chest diseases specialist, assistant doctor, nurse and anesthesiologist who will perform the bronchoscopy procedure. Hospitalization and invasive procedures are known to cause anxiety and anxiety in both pediatric patients and their parents. Children have limited cognitive development, limited understanding of illness, and poor strategies for coping with illness. Parents who care for their children may also perceive this process differently and their anxiety management may change, depending on their own temperament, age, socioeconomic status, education level, chronic organic disease and psychiatric disease diagnoses, if any. It is important to detect anxiety and anxiety with valid and clinically valuable tools to detect and combat it. Aim: The aim of our study is to evaluate the level of anxiety and anxiety before and after the procedure in children who are planned to undergo bronchoscopy in the hospital and to identify predictors, if any. Material and method: This study included 84 cases under the age of 18 who were hospitalized with the indication of flexible bronchoscopy to the Celal Bayar University Pediatric Pulmonology Department and Pediatric Allergy and Immunology Department between September 2023 and January 2025. The name, surname, age, gender, height, weight of the cases, whether the bronchoscopy was diagnostic or therapeutic, the indication for bronchoscopy, the number of times and duration of previous hospitalization, if any, the known accompanying diseases and known mental disorders, if any, were recorded. The names, surnames, ages, education levels, employment status, chronic diseases and psychiatric diagnoses, if any, of their parents are recorded. Before flexible bronchoscopy, the patients' families are informed about the indications, purpose, reliability and possible complications of this procedure to be performed on their children. Written consent is obtained from the families and informed consent is obtained for the volunteer form for participation in the survey study to determine the anxiety level. Before, after and during the bronchoscopy procedure, the answers given by both the child and his/her parent to the STAI and SDQ questionnaires are recorded. Results and Discussion: The average age of 48 male and 36 female patients, a total of 84 children, was calculated as 5.28±4.33 (0.1-17.0) years. The average height of the patients was 108.0±30.3 cm and the average weight was 22.6±17.5 kg. 86.9% of bronchoscopy performed on pediatric patients was performed for diagnostic purposes and 13% for therapeutic purposes. The most frequently determined indication for bronchoscopy was to investigate the etiology of chronic cough in 33.3% of patients, while wheeze etiology research and uncontrolled asthma were determined as the second and third most frequent indications for bronchoscopy. 2.4% of the pediatric patients who underwent bronchoscopy had psychogenic cough and 1.2% had anxiety. The average age of the mother was found to be 33.9±7.27 (22.0-52.0) years. While 31.0% of mothers were working, 31.3% were university graduates, 34.9% were high school graduates and 14.5% were secondary school graduates. While the presence of chronic disease in the mother was 22.9%, the presence of psychiatric disease was 4.8%. While the average number of hospitalizations of pediatric patients who underwent bronchoscopy was 3.00±2.43 (1-13), the average hospitalization period was 30.30±54.70 (1-360) days. It was determined that the Flexible Bronchoscopy procedure performed in the hospital increased the anxiety and anxiety levels in the child and the mother, and that the anxiety and anxiety levels decreased in the control after discharge. The anxiety experienced by both the child and his mother causes difficulties in the child and mother's attention, hyperactivity, affect, behavior, and peer relationships, and was found to be statistically significant. These difficulties they experience can affect their life. The child's age, the mother's age, and the mother's working status can also affect this process. In addition, it is possible to pay attention to the organic disease and psychiatric disease diagnoses of children and mothers, their previous hospital experiences, education levels, cognitive levels, and socioeconomic status, and to make explanations and process management in a more comfortable and less anxiety-causing way, taking into account these predictors. Conclusion: In this process, it is important to identify high-risk children and parents who are likely to develop anxiety and anxiety and experience difficulties, and to work in collaboration with child and adolescent mental health diseases and adult psychiatry. Cognitive, behavioral and pharmacological interventions to reduce anxiety can be developed. Negative hospital, operating room and invasive procedure experiences can be prevented. It can help you go through more positive and positive processes in the next healthcare process. Key Words : flexible bronchoscopy, child, parent, anxiety, diffuculty