Preoperative Preparation Programs in Children: A Comparative Examination Family-centered Preparation for Surgery Improves Perioperative Outcomes in Children: A Randomized Controlled Trial Preoperative anxiety and intraoperative anesthetic requirements. Sensory Stimuli and Anxiety in Children Undergoing Surgery: A Randomized, Controlled Trial Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients Imagery reduces children's post-operative pain Preoperative anxiety in children. Predictors and outcomes. Risk factors for postoperative anxiety in children The effectiveness of a storybook in lessening anxiety in children undergoing tonsillectomy and adenoidectomy in northern ireland Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access. Streamed Video Clips to Reduce Anxiety in Children During Inhaled Induction of Anesthesia Preparing children and families psychologically for day surgery: an evaluation. Cartoon Distraction Alleviates Anxiety in Children During Induction of Anesthesia Premedication in children: hypnosis versus midazolam. Distraction with a hand-held video game reduces pediatric preoperative anxiety. The effects of vicarious and cognitive rehearsal on pain tolerance. Anesthesia Induction Using Video Glasses as a Distraction Tool for the Management of Preoperative Anxiety in Children A randomized controlled trial of an at-home preparation programme for Japanese preschool children: effects on children's and caregivers' anxiety associated with surgery. Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option? Preoperative anxiety in adolescents undergoing surgery: a pilot study.
We sought to determine whether an extensive behavioral preparation program for children undergoing surgery is more effective than a limited behavioral program . The primary end point was  child and parent anxiety during the preoperative period . Secondary end points included behavior of the child during the induction of anesthesia and the postoperative recovery period . Several days before surgery , children ( n = 75 ) aged 2 - 12 yr r and omly received either an information-based program ( OR tour ) , an information + modeling-based program ( OR tour + videotape ) , or an information + modeling + coping-based program ( OR tour + videotape + child-life preparation ) . Using behavioral and physiological measures of anxiety , we found that children who received the extensive program exhibited less anxiety immediately after the intervention , in the holding area on the day of surgery , and on separation to the operating room . These findings , however , achieved statistical significance only in the holding area on the day of surgery ( 44[10 - 72 ] vs 32[8 - 50 ] vs 9[6 - 33 ] ; P = 0.02 ) . Similarly , parents in the extensive program were significantly less anxious on the day of surgery in the preoperative holding area , as assessed by behavioral ( P = 0.015 ) and physiological measures ( P = 0.01 ) . In contrast , no differences were found among the groups during the induction of anesthesia , recovery room period , or 2 wk postoperatively . We conclude that children and parents who received the extensive preoperative preparation program exhibited lower levels of anxiety during the preoperative period , but not during the intraoperative or postoperative periods . Implication s : The extensive behavioral preoperative program that we undertook had limited anxiolytic effects . These effects were localized to the preoperative period and did not extended to the induction of anesthesia or the postoperative recovery period . ( Anesth Analg 1998;87:1249 - 55 Background : Children and parents experience significant anxiety and distress during the preoperative period . Currently available interventions are having limited efficacy . Based on an integration of the literature in both the anesthesia and psychological milieus , the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole . Methods : Children and their parents ( n = 408 ) were r and omly assigned to one of four groups : ( 1 ) control : received st and ard of care ; ( 2 ) parental presence : received st and ard parental presence during induction of anesthesia ; ( 3 ) ADVANCE : received family-centered behavioral preparation ; and ( 4 ) oral midazolam . The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium . Results : Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups ( 34.4 ± 16 vs. 39.7 ± 15 ; P = 0.007 ) and were less anxious during induction of anesthesia as compared with the control and parental presence groups ( 44.9 ± 22 vs. 51.6 ± 25 and 53.6 ± 25 , respectively ; P = 0.006 ) . Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups ( 44.9 ± 22 vs. 42.9 ± 24 ; P = 0.904 ) . Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery ( P = 0.038 ) , required significantly less analgesia in the recovery room ( P = 0.016 ) , and were discharged from the recovery room earlier ( P = 0.04 ) as compared with children in the three other groups . Conclusion : The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes UNLABELLED The purpose of this study was to determine whether larger doses of anesthetics are required in the anxious patient to establish and maintain a clinical ly sufficient hypnotic component of the anesthetic state . Fifty-seven women undergoing bilateral laparoscopic tubal ligation with a propofol-based anesthetic regimen  were enrolled in this cross-sectional study . Trait ( baseline ) and state ( situational ) anxiety were assessed in all patients immediately before surgery , and the propofol doses required for the induction and maintenance of anesthesia were recorded . A  bispectral index monitor was used to assure that the hypnotic component of the anesthetic state was the same in all patients . We found that patients with high trait anxiety required more propofol for both the induction ( 2.1+/-0.4 vs 1.8+/-0.3 mg/kg ; P = 0.01 ) and maintenance of anesthesia ( 170+/-70 vs 110+/-20 microg x kg(-1 ) x min(-1 ) ; P = 0.02 ) , compared with patients with low trait anxiety . State anxiety , however , was not found to affect the propofol doses required for the induction or maintenance of anesthesia . Multiple regression models confirmed that Trait anxiety is an independent predictor for intraoperative propofol requirements ( P = 0.02 ) . We conclude that increased baseline ( i.e. , trait ) anxiety is associated with increased intraoperative anesthetic requirements . Thus , we suggest that the initial dose of anesthetic administered by an anesthesiologist should be modified based on the anxiety level exhibited by the patient . IMPLICATION S The goal of this study was to assess the relationship between preoperative anxiety and intraoperative anesthetic requirements . We found that high baseline anxiety predicts increased intraoperative anesthetic requirements . We suggest that anesthesiologists should modify the initial induction dose based on the anxiety level exhibited by the patient We assessed the effectiveness of a behavioral intervention aim ed at reducing the anxiety of children undergoing anesthesia and surgery . The intervention consisted of dimmed operating room ( OR ) lights ( 200 Lx ) and soft background music ( Bach ’s “ Air on a G String , ” 50–60 dB ) . Only one person , the attending anesthesiologist , interacted with the child during the induction of anesthesia . Children undergoing anesthesia and surgery were r and omly assigned either to a low sensory stimulation group ( LSSG , n = 33 ) or to control group ( n = 37 ) . By using vali date d behavioral measures of anxiety ( mYPAS ) and compliance ( ICC ) , children were evaluated at the preoperative holding area and during the induction of anesthesia . On postoperative Days 1 , 2 , 3 , 7 , and 14 , the behavioral recovery of the children was assessed by using the Post Hospitalization Behavior Question naire . We found that the LSSG was significantly less anxious compared with the control group on entrance to the OR ( P = 0.03 ) and on the introduction of the anesthesia mask ( P = 0.003 ) . Also , the compliance during the induction of anesthesia was significantly better in children assigned to the LSSG ( P = 0.02 ) . The incidence of postoperative behavioral changes , however , did not differ significantly between the two groups ( P = ns ) . We conclude that children who are exposed to low-level sensory stimuli during the induction of anesthesia and who are exposed to background music exhibit lower levels of anxiety and increased compliance Background : To compare oral midazolam ( 0.5 mg/kg ) with oral butorphanol ( 0.2 mg/kg ) as a premedication in 60 pediatric patients with regards to sedation , anxiolysis , rescue analgesic requirement , and recovery profile . Material s and Methods : In a double blinded study design , 60 pediatric patients belonging to ASA class I and II between the age group of 2–12 years scheduled for elective surgery were r and omized to receive either oral midazolam ( group I ) or oral butorphanol ( group II ) 30 min before induction of anesthesia . The children were evaluated for levels of sedation and anxiety at the time of separation from the parents , venepuncture , and at the time of facemask application for induction of anesthesia . Rescue analgesic requirement , postoperative recovery , and complications were also recorded . Results : Butorphanol had better sedation potential than oral midazolam with comparable anxiolysis at the time of separation of children from their parents . Midazolam proved to be a better anxiolytic during venepuncture and facemask application . Butorphanol  reduced need for supplemental analgesics perioperatively without an increase in side effects such as nausea , vomiting , or unpleasant postoperative recovery . Conclusion : Oral butorphanol is a better premedication than midazolam in children in view of its excellent sedative and analgesic properties . It does not increase side effects significantly PURPOSE / OBJECTIVES To determine the effects of virtual reality ( VR ) glasses on adolescents with cancer undergoing lumbar punctures ( LPs ) . DESIGN Pilot study using an experimental , control group design . SETTING In-hospital oncology clinic . SAMPLE 30 adolescents with cancer ( 17 in the VR and 13 in the control group ) undergoing frequent LPs . METHODS Subjects were r and omly assigned to groups . Both groups received st and ard intervention during the LP , but the experimental group also wore VR glasses and watched a video . Following the LP , both groups rated their pain using a visual analog scale ( VAS ) and were interviewed to evaluate their experience . MAIN RESEARCH VARIABLES Pain , subjective evaluation of experience . FINDINGS Although VAS pain scores were not statistically different between the two groups ( p = 0.77 ) , VAS scores tended to be lower in the VR group ( median VAS of 7.0 , range 0 - 48 ) than in the control group ( median VAS of 9.0 , range 0 - 59 ) . 77 % of subjects in the experimental group said the VR glasses helped to distract them from the LP . CONCLUSIONS VR glasses are a feasible , age-appropriate , nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents . IMPLICATION S FOR PRACTICE The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored Background Children and parents experience significant anxiety and distress during the preoperative period . This is important because preoperative anxiety in children is associated with adverse postoperative outcome . So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application , world-widely used . Methods A total 120 patients ( aged 1 - 10 years old ) who were scheduled for elective surgery under general anesthesia was included in this r and omized controlled trial . We r and omized the patients into three groups , with using intravenous ( IV ) midazolam sedation ( M group ) , with using smartphone application program ( S group ) , and with using low dose IV midazolam plus smartphone application program ( SM group ) . And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale ( mYPAS ) at holding area , 5 min after intervention , entrance to operating room . Results In all three groups , mYPAS after intervention were lower than the preoperative holding area ( M group 52.8 ± 11.8 vs 41.0 ± 7.0 , S group 59.2 ± 17.6 vs 36.4 ± 7.3 , SM group 58.3 ± 17.5 vs 26.0 ± 3.4 ) . A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group ( P < 0.01 ) , and the SM group exhibited significantly lower anxiety than the two other groups ( P < 0.01 ) . Conclusions The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety & NA ; This un‐blinded experimental study investigated the effectiveness of imagery , in addition to routine analgesics , in reducing tonsillectomy and /or adenoidectomy pain and anxiety after ambulatory surgery ( AS ) and at home . Seventy‐three children , aged 7–12 , were recruited from five AS setting s. Thirty‐six children r and omly assigned to the treatment group  watched a professionally developed videotape on the use of imagery and then listened to a 30‐min audio tape of imagery approximately 1 week prior to surgery ( T1 ) . They listened to only the audio tape 1–4 h after surgery ( T2 ) , and 22–27 h after discharge from AS ( T3 ) . The 37 children in the attention‐control group received st and ard care . Pain and anxiety were measured at each time‐point in both groups . Measures of sensory pain were the Oucher and amount of analgesics used in AS and home ; affective pain was measured with the Facial Affective Scale ( FAS ) . Anxiety was measured using the State Trait Anxiety Inventory for Children ( STAIC ) . When controlling for trait anxiety and opioid and non‐opioid intake 1–4 h before the pain measures , MANCOVA showed significantly lower pain and anxiety in the treatment group at T2 , but not at T3 . When controlling for trait anxiety , a two‐way RM MANCOVA indicated no significant group differences in combined opioid and non‐opioid use between the groups , or between times . Appropriately trained health care providers should use imagery to reduce post‐operative pain following tonsillectomy and /or adenoidectomy in AS . Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home OBJECTIVE To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery . DESIGN A prospect i ve , longitudinal study . SETTING A university children 's hospital . PARTICIPANTS One hundred sixty-three children , 2 to 10 years of age ( and their parents ) , who underwent general anesthesia and elective surgery .  MAIN OUTCOME MEASURES In the preoperative holding area , anxiety level of the child and parents was determined using self-reported and independent observational measures . At separation to the operating room , the anxiety level of the child and parents was rated again . Postoperative behavioral responses were evaluated 3 times ( at 2 weeks , 6 months , and 1 year ) . RESULTS A multiple regression model ( R2 = 0.58 , F = 6.4 , P = .007 ) revealed that older children and children of anxious parents , who received low Emotionality , Activity , Sociability , and Impulsivity ( EASI ) ratings for activity , and with a history of poor- quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area . A similar model ( R2 = 0.42 , F = 8.6 , P = .001 ) revealed that children who received low EASI ratings for activity , with a previous hospitalization , who were not enrolled in day care , and who did not undergo premedication were more anxious at separation to the operating room . Overall , 54 % of children exhibited some negative behavioral responses at the 2-week follow-up . Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up , and , in 7.3 % of the children , these behaviors persisted at 1-year follow-up . Nightmares , separation anxiety , eating problems , and increased fear of physicians were the most common problems at 2-week follow-up . Multivariate analysis demonstrated that child 's age , number of siblings , and immediate preoperative anxiety of the child and mother predicted later behavioral problems . CONCLUSIONS Variables such as situational anxiety of the mother , temperament of the child , age of the child , and quality of previous medical encounters predict a child 's preoperative anxiety . Although immediate negative behavioral responses develop in a relatively large number of young children following surgery , the magnitude of these changes is limited , and long-term maladaptive behavioral responses develop in only a small minority Background : Anxiety is defined as a set of behavioural manifestations that can be divided into state‐ and trait‐anxiety . State‐anxiety is a transitory emotional condition that varies in intensity and fluctuates over time . Trait‐anxiety is a personality trait which remains relatively stable over time . The objective of this study was to identify and quantify perioperative risk factors for immediate postoperative anxiety in children Aim : This study aim ed to assess the effectiveness of a storybook , entitled , The Tale of Woody ’s Tonsils , written by Anne Marie Tunney , on reducing the level of anxiety of children aged 5–11 years who were undergoing tonsillectomy and adenoidectomy in one hospital in Northern Irel and . Background / Literature Review : Psychological preparation of children for surgery impacts coping . There is evidence , in both adult and pediatric studies , that effective psychological preparation for a surgical procedure has an impact on the individuals ’ coping ability with reduced levels of anxiety leading to better post-operative outcome , faster recovery and a reduction in long term sequelae associated with admission to hospital . A storybook , as a method of preparation , has been recommended by a number of research ers but the effectiveness of this in reducing anxiety has not yet been investigated in the UK . Previous studies have mainly used only one research instrument for anxiety measurement and child self-report is not a commonly used feature of such research . Design and Methodology : A quasi-experimental study involving 80 children was conducted using a repeated measures design . Children attending a pre- assessment clinic were r and omly allocated to either an experimental group ( received the storybook ) or a control group ( did not get the storybook ) . Anxiety was tested both pre- and post-intervention using a self-report Hospital Fears Rating Scale and Child Drawing : Hospital , a projective technique based on children ’s drawings . Findings : The storybook was found to be effective in reducing pre-operative anxiety and was found to be particularly effective for females and in the 7-year-old age group . Practice Implication s ; This study demonstrates the storybook ’s effectiveness for alleviating anxiety and advocates the use of child focused anxiety measurement tools . It reinforces the need for pre assessment to include exploration of anxiety triggers so that preoperative preparation and nursing care can be individualized for each child This study evaluated a distraction intervention design ed to reduce the distress of preschool children undergoing repeated chemotherapy injections . Twenty-nine children aged 2 - 5 years were r and omly assigned either to distraction by a developmentally appropriate electronic toy or to a wait-list control . Children who received the distraction intervention demonstrated lower overt behavioral distress and were rated by parents and nurses as less anxious than children in the control condition . The improvements were maintained over the 8-week intervention . The results suggest that a developmentally appropriate , multisensory , variable-distracting activity that requires active cognitive processing and active motor responses may be a viable cost-effective alternative to more time-intensive parent-training programs for preschool-age children BACKGROUND : Anesthesia induction in children is frequently achieved by inhalation of nitrous oxide and sevoflurane . Pediatric anesthesiologists commonly use distraction techniques such as humor or nonprocedural talk to reduce anxiety and facilitate a smooth transition at this critical phase . There is a large body of successful distraction research that explores the use of video and television distraction methods for minor medical and dental procedures , but little research on the use of this method for ambulatory surgery . In this r and omized control trial study we examined whether video distraction is effective in reducing the anxiety of children undergoing inhaled induction before ambulatory surgery . METHODS : Children ( control = 47 , video = 42 ) between 2 and 10 years old undergoing ambulatory surgery were r and omly assigned to a video distraction or control group . In the video distraction group a video clip of the child ’s preference was played during induction , and the control group received traditional distraction methods during induction . The modified Yale Preoperative Anxiety Scale was used to assess the children ’s anxiety before and during the process of receiving inhalation anesthetics . RESULTS : All subjects were similar in their age and anxiety scores before entering the operating rooms . Children in the video distraction group were significantly less anxious at induction and showed a significantly smaller change in anxiety from holding to induction than did children in the control group . CONCLUSIONS : Playing video clips during the inhaled induction of children undergoing ambulatory surgery is an effective method of reducing anxiety . Therefore , pediatric anesthesiologists may consider using video distraction as a useful , valid , alternative strategy for achieving a smooth transition to the anesthetized state The increasing use of ambulatory care setting s for children 's surgery places more responsibility on parents for psychological preparation of children for surgery and for their post-operative care . This paper describes the evaluation of a pre-admission programme to prepare children between the ages of 3 and 15 years and their families psychologically for day surgery . Seventy-five families comprised the study sample , 23 in the programme group and 53 in the non-intervention group . The programme focused on familiarizing families with the physical and procedural components of day surgery through a videotape of a family in a naturally occurring day surgery situation , a tour , and hospital play . Fewer children and parents in the programme group reported high anxiety levels awaiting surgery . Children and parents with previous surgical experience reported higher levels of pre-surgical anxiety than inexperienced families . Families reported the physicians and day surgery nurse as their primary sources of information and rated the day surgery nurse highest in their satisfaction with information received . Implication s for practice , particularly for meeting the needs of young children and out-of-town families , are discussed BACKGROUND : We performed this study to determine the beneficial effects of viewing an animated cartoon and playing with a favorite toy on preoperative anxiety in children aged 3 to 7 years in the operating room before anesthesia induction . METHODS : One hundred thirty children aged 3 to 7 years with ASA physical status I or II were enrolled . Subjects were r and omly assigned to 1 of 3 groups : group 1 ( control ) , group 2 ( toy ) , and group 3 ( animated cartoon ) . The children in group 2 were asked to bring their favorite toy and were allowed to play with it until anesthesia induction . The children in group 3 watched their selected animated cartoon until anesthesia induction . Children ’s preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale ( mYPAS ) and parent-recorded anxiety Visual Analog Scale ( VAS ) the night before surgery , in the preanesthetic holding room , and just before anesthesia induction . RESULTS : In the preanesthetic holding room , the group 2 mYPAS and parent-recorded anxiety VAS scores were significantly lower than those of groups 1 and 3 ( mYPAS : P = 0.007 ; parent-recorded anxiety VAS : P = 0.02 ) . In the operating room , the children in group 3 had the lowest mYPAS and parent-recorded anxiety VAS scores among the 3 groups ( mYPAS : P < 0.001 ; parent-recorded anxiety VAS : P < 0.001 ) . In group 3 , the mYPAS and parent-recorded anxiety VAS scores of only 3 and 5 children were increased in the operating room compared with their scores in the preanesthetic holding room , whereas the anxiety scores of 32 and 34 children in group 1 and 25 and 32 children in group 2 had increased ( P < 0.001 ) . The number of children whose scores indicated no anxiety ( mYPAS score < 30 ) in the operating room was 3 ( 7 % ) , 9 ( 23 % ) , and 18 ( 43 % ) in groups 1 , 2 , and 3 , respectively ( P < 0.001 ) . CONCLUSIONS : Allowing the viewing of animated cartoons by pediatric surgical patients is a very effective method to alleviate preoperative anxiety . Our study suggests that this intervention is an inexpensive , easy to administer , and comprehensive method for anxiety reduction in the pediatric surgical population BACKGROUND The main objectives of premedication in children are to facilitate the separation from the parents , to reduce preoperative anxiety , to smooth the induction of anesthesia and to lower the risk of postoperative behavioral disorders . The most common technique is sedative premedication with midazolam . Hypnosis enables a state of relaxation to be achieved and has never been evaluated as a premedication technique . The aim of the present study was to evaluate the efficacy of hypnosis on anxiety and perioperative behavioral disorders versus midazolam . METHODS Fifty children from 2 to 11 years of age were r and omized into two groups : group H received hypnosis as premedication ; group M were given 0.5 mg x kg(-1 ) midazolam orally , 30 min before surgery . Preoperative anxiety was evaluated using the Modified Yale Preoperative Anxiety Scale ( mYPAS ) score when arriving in the department ( T1 ) , when entering the operating room ( T2 ) , and when fitting the facemask ( T3 ) . Postoperative behavioral disorders were evaluated using the Posthospitalization Behavioral Question naire ( PHBQ ) at days 1 , 7 and 14 . RESULTS The two groups showed no significant difference preoperatively with the PHBQ : ( M ) 21 ( 17 - 25 ) vs ( H ) 20 ( 8 - 25 ) and mYPAS score : ( M ) 28 ( 23 - 75 ) vs ( H ) 23 ( 23 - 78 ) . The number of anxious children was less during induction of anesthesia in the hypnosis group ( T3 : 39 % vs 68 % ) ( P < 0.05 ) . Postoperatively , hypnosis reduced the frequency of behavior disorders approximately by half on day 1 ( 30 % vs 62 % ) and day 7 ( 26 % vs 59 % ) . CONCLUSIONS Hypnosis seems effective as premedication in children scheduled for surgery . It alleviates preoperative anxiety , especially during induction of anesthesia and reduces behavioral disorders during the first postoperative week BACKGROUND Video games have received widespread application in health care for distraction and behavior modification therapy . Studies on the effect of cognitive distraction during the preoperative period are lacking . We evaluated the efficacy of an interactive distraction , a h and -held video game ( VG ) in reducing preoperative anxiety in children . METHODS In a r and omized , prospect i ve study of 112 children aged 4 - 12 years undergoing outpatient surgery , anxiety was assessed after admission and again at mask induction of anesthesia , using the modified Yale Preoperative Anxiety Scale ( mYPAS ) . Postoperative behavior changes were assessed with the Posthospital Behavior Question naire ( PHBQ ) . Patients were r and omly assigned to three groups : parent presence ( PP ) , PP+a h and -held VG , and PP+0.5 mg.kg-1 oral midazolam ( M ) given>20 min prior to entering the operating room . RESULTS There was a statistically significant increase in anxiety ( P<0.01 ) in groups M and PP at induction of anesthesia compared with baseline , but not in VG group . VG patients demonstrated a decrease in anxiety from baseline ( median change in mYPAS -3 ) , the difference compared with PP ( + 11.8 ) was significant ( P=0.04 ) . The change in anxiety in the M group ( + 7.3 ) was not statistically different from other groups . Sixty-three percent of patients in VG group had no change or decrease in anxiety after treatment , compared with 26 % in M group and 28 % in PP group ( P=0.01 ) . There was no difference in anxiety changes between female and male patients . CONCLUSIONS A h and -held VG can be offered to most children as a low cost , easy to implement , portable , and effective method to reduce anxiety in the preoperative area and during induction of anesthesia . Distraction in a pleasurable and familiar activity provides anxiety relief , probably through cognitive and motor absorption Several aspects of  rehearsing an aversive experience  were investigated in relation to subsequent tolerance of the experience . The aversive experience consisted of radiant-heat pain . Rehearsal by observing another person undergoing the experience was compared to rehearsal by hearing a detailed description of the experience . The content of rehearsal involving the same pain stimulus as that to be experienced ( relevant ) was compared to the content involving a different type of pain stimulus ( irrelevant ) . The effect of rehearsal during the first vs. the second exposure to the pain stimulus was also investigated . Results showed no differences in effectiveness between vicarious and cognitive rehearsal , but after the first exposure to the pain , Ss whose rehearsal was relevant had significantly higher pain tolerance than those whose rehearsal was irrelevant BACKGROUND : Distraction technology suitable for the perioperative setting is readily available , but there is little evidence to show how it compares with oral midazolam in managing anxiety . Video glasses , which enable children to view and listen to cartoons and movies , may be used through the completion of inhaled induction . We compared the efficacy of oral midazolam and behavioral distraction with video glasses in managing preoperative anxiety in children . METHODS : In this prospect i ve , r and omized study , 96 children aged 4 to 9 years undergoing outpatient surgery were recruited to one of 3 intervention groups receiving midazolam , video glasses , or both . The Modified Yale Preoperative Anxiety Scale was the primary dependent measure used to assess anxiety at baseline before intervention , 20 minutes later at transport to the operating room ( OR ) , and during mask induction . RESULTS : There was no significant increase in anxiety score within any group between baseline and OR transport ( P = 0.21 , 0.42 , and 0.57 for midazolam , video glasses , and combined groups , respectively ) . An increase in anxiety , though not large enough to be clinical ly significant , was observed from baseline to induction in the midazolam and combined groups ( P = 0.02 and 0.03 ) but not in the video glasses group ( P = 0.38 ) . Confidence intervals for pairwise comparisons in Modified Yale Preoperative Anxiety Scale changes among groups were all within a clinical ly significant difference of 15 units . CONCLUSIONS : The use of video glasses and midazolam alone or in combination maintains baseline levels of anxiety at time of transport to the OR and prevents significantly increased anxiety during induction of anesthesia in children . Video glasses are not inferior to midazolam for preoperative anxiolysis and provide a safe , noninvasive , nonpharmacologic , and pleasant alternative OBJECTIVES To determine whether the implementation of at-home psychological preparation programme for children and family prior to surgery can reduce anxiety for Japanese preschool children undergoing herniorrhaphy and their caregivers assessed as an appropriate outpatient care . METHODS Patients were r and omly assigned to either of two groups : the usual care group or the at-home preparation group . Both two groups viewed a patient-educational video for herniorrhaphy once as out patients with other patients prior to hospitalization . The control group later underwent surgery without any further preparation . The experimental group watched the same educational video at home again with an auxiliary booklet prior to hospitalization . Children 's anxiety was measured by the Wong-Baker FACES Rating Scale ( FACES Rating Scale ) , while caregivers ' anxiety was measured by the Spielberger 's State Trait Anxiety Inventory ( STAI ) . Both outcomes were measured repeatedly from pre-intervention to 1 month after surgery . RESULTS Of the eligible 161 patients participating , 158 ( 98.1 % ) were r and omly assigned to the control group ( n = 81 ) and the experimental group ( n = 77 ) , and 144 ( 89.4 % ) completed the study . The experimental group gained more information and knowledge about surgery from parents and showed significantly lower scores than the controls for FACES and STAI . CONCLUSION A specially design ed at-home preparation programme as an outpatient care is effective to encourage parent-child verbal interaction concerning surgery and reduce both children and caregivers ' anxiety associated with surgery BACKGROUND AND OBJECTIVES A significant number of children undergo surgery experience high levels of anxiety in the presurgical period . The aim of this study is to investigate which intervention is more effective in reducing preoperative anxiety . METHODS / MATERIAL S The sample was composed of 75 subjects ( aged 5 - 12 years ) who had to undergo minor day surgery . Children were r and omly assigned to : the Clowns group ( N = 25 ) accompanied to the preoperative room by the clowns and by a parent ; Premedication group ( N = 25 ) premedicated with oral midazolam and accompanied to the preoperative room by one parent ; or the Control group ( N = 25 ) only accompanied by one parent .  Anxiety in the preoperative period was measured by using the Modified Yale Preoperative Anxiety Scale ( m-YPAS ) . Parental anxiety was measured by using the State-Trait Anxiety Inventory ( STAI Y-1/Y-2 ) . RESULTS The Clown group was significantly less anxious during the induction of anesthesia compared with Premedication group and Control group . There were not any significant differences between Control group and Premedication group . There was an increased level of anxiety in the induction room in comparison with the waiting room : this difference was statistically significant for Control group and Premedication group , whereas it was not significant in Clown group . CONCLUSIONS PPIA+clown intervention is more effective in reducing anxiety in children during the preoperative period than PPIA alone or PPIA+oral midazolam OBJECTIVES The purpose of this study was to conduct a prospect i ve assessment of preoperative anxiety in adolescents undergoing surgery . AIM To systematic ally conduct a multimodal evaluation of preoperative anxiety in adolescents undergoing surgery . BACKGROUND The existing literature on preoperative anxiety in children has overwhelmingly ignored adolescents in the surgical setting , yet adolescents may be at risk for undertreatment of preoperative anxiety . METHODS A total of 59 adolescents aged 11 - 18 were recruited . Behavioral and physiological manifestations of anxiety were assessed with a  visual analog scale and an ambulatory physiological data recorder  that collected heart rate ( HR ) , skin conductance level ( SCL ) , and blood pressure data . Baseline emotional and behavioral functioning ( child behavior checklist [ CBCL ] ) as well as temperament ( early adolescent temperament question naire-revised -- parent version ) and other potential risk factors were also assessed . RESULTS Over 80 % of adolescents reported significant anxiety at the time of induction . Self-reported anxiety increased significantly at each time point ( holding , separation from parents , and mask introduction ) , P=0.001 . Significant increases in both HR ( P=0.02 ) and SCL ( P<0.001 ) were found from holding to mask introduction . Several risk factors were found to predict higher anxiety at mask introduction , including baseline anxiety and depression ( CBCL , Internalizing , P=0.04 ) , somatizing problems ( P=0.05 ) , and fearful temperament ( P=0.03 ) . CONCLUSIONS A large proportion of adolescents experience significant anxiety that increases from the preoperative holding area to anesthesia induction . Underlying baseline anxiety and depression as well somatization and fearful temperament are predictors of this phenomenon
OBJECTIVE To examine the effectiveness of Audiovisual ( AV ) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery .