Preparation of parents by teaching of distraction techniques does not reduce child anxiety at anaesthetic induction.

Abstract

Introduction For those children having surgery, induction of anaesthesia is one of the most stressful procedures the child experiences perioperatively. Current work has failed to show a benefit of parental presence at induction of anaesthesia for all children. The reasons for lack of effect may include the high anxiety levels of some parents and also that the role for parents at their child's induction is not delineated. The main aim of this study was to see if parental preparation by teaching of distraction techniques could reduce their child's anxiety during intravenous induction of anaesthesia. Methods After ethics committee approval 40 children aged 2–10 years old, ASA status I or II undergoing daycase surgery under general anaesthesia were enrolled into the study. To avoid possible confounding factors children with a history of previous, surgery, chronic illness or developmental delay were excluded form participation. No children were given sedative premedication. After written informed consent by the parent, each child and parent was randomly assigned to an intervention or control group. Parents in the intervention group received preparation from a play specialist working on the children's surgical ward. It involved preparation for events in the anaesthetic room and instruction on methods of distraction for their child during induction using novel toys, books or blowing bubbles appropriate to the child's age. Preoperative information collected included demographic and baseline data. The temperament of the child was measured using the EASI (Emotionality, Activity, Sociability, Impulsivity) instrument of child temperament(l). In the anaesthetic room all children were planned to have intravenous induction of anaesthesia after prior application of EMLA cream. Anxiety of the child was measured by the modified Yale Preoperative Anxiety Scale (mYPAS)(2) by a blinded independent observer at three time points: entrance to the anaesthetic room, intravenous cannulation and at anaesthesia induction. Cooperation of the child was measured by the Induction Compliance Checklist (ICC) by the same observer (3). Postoperative data collected included parental satisfaction and anxiety scores measured by the Stait Trait Anxiety Inventory (STAI)(4) and at one week the behaviour of the child was measured Using the Posthospitalisation Behavioural Questionnaire (PHBQ)(5). Normally distributed data were analysed by a two‐sample t‐test, categorical data by Pearson's Chi‐squared test and non‐parametric data by the Wilcoxon rank‐sum test. Results One parent withdrew after enrolment. This left 22 children in the control group and 17 in the intervention group. There were no significant differences in demographic and baseline data of the children between the two groups including ethnic origin, number of siblings, birth order of the child, recent stressful events in the child's life, previous hospital admissions and the temperament of the child. Parent demographics were also similar between groups including parent's age, sex, relationshi...

Distraction with a hand‐held video game reduces pediatric preoperative anxiety

“…Music‐assisted relaxation seemed to have a significant reduction in preoperative anxiety in a small sample of children (21). Preparation of parents by a play specialist for events in the anesthetic room and methods of distraction employed during induction using novel toys, books or blowing bubbles did not reduce anxiety compared with PP alone (10). Kain et al found that interactive music therapy by a group of musicians playing to children during the preoperative period until induction of anesthesia was effective in alleviating anxiety on separation from parents and entry into the operating room, but not during induction of anesthesia.…”

“…The VG intervention might be considered an unexpected ‘gift’ which children find pleasurable, thus, decreasing anxiety. Yet, without the active distraction and mental and motor participation, it is unlikely that a gift alone would provide anxiolysis as a study using distraction with novel toys, books, and bubble blowing was not any more effective than PP (10).…”

“…Distraction techniques such as music and toys have been used with variable success to decrease pain from intravenous cannulation (8,9), but their effectiveness during the induction of anesthesia has not been established (10,11). Anesthesiologists continue to search for a low cost, easy to administer, and comprehensive method for anxiety reduction in the pediatric surgical population.…”

Induction of anesthesia in a combative child; management and issues

“…This second group may tend to have a certain demographic profile, involving anxious temperament, previous distress, age 3 or 4 years old and with parental anxiety (10,11), and this group may be more amenable to persuasion or distraction. Both groups can be further influenced by repeated interventions (12), recent stress or painful procedures (10).…”

Beyond pain: predictors of postoperative maladaptive behavior change in children

“…The development of the Post Hospitalization Behavioral Questionnaire (PHBQ) by Vernon prompted a large number of investigators to address the issue of new onset postoperative behavioral changes in children with a systematic approach (6). The PHBQ is a parent-report observational questionnaire that has been widely studied to examine behavioral outcomes in children following surgery as well as the effectiveness of preoperative interventions on postoperative behavioral outcomes (2,7,8,(9)(10)(11)(12)(13)(14). The PHBQ has been translated into several languages and is currently considered to be the 'gold standard' for postoperative behavioral assessment (6,15,16).…”