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Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial
1Department of Anesthesia and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
Insights
Specially trained clowns significantly reduced preoperative anxiety in children undergoing surgery. However, their anxiety-reducing effects diminished once the anesthesia mask was applied.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Medical Intervention Studies
Background:
- Preoperative anxiety is common in children undergoing surgery.
- Anxiety can negatively impact anesthetic induction and recovery.
- Current interventions include pharmacological (e.g., midazolam) and non-pharmacological methods.
Purpose of the Study:
- To evaluate the efficacy of trained clowns in reducing preoperative anxiety in children.
- To compare the effect of clowns to midazolam and no intervention on anesthetic induction.
- To assess the duration of the clowns' impact on anxiety levels.
Main Methods:
- Randomized, controlled, blinded study with children aged 3-8 years.
- Three groups: no intervention, midazolam, or trained clowns.
- Anxiety assessed using the modified-Yale Preoperative Anxiety Scale (m-YPAS).
Main Results:
- Clown group showed significantly lower m-YPAS scores in the preoperative holding area compared to control and midazolam groups.
- Anxiety reduction in the clown group persisted into the operating room, equaling the midazolam group.
- No significant difference in anxiety was detected between groups upon anesthesia mask application.
Conclusions:
- Medically trained clowns are effective in alleviating preoperative anxiety in pediatric surgical patients.
- The positive impact of clowns on anxiety is most pronounced before anesthesia induction.
- Clowns do not influence anxiety levels once the anesthesia mask is introduced.
Objective:
To determine if specially trained professional clowns allayed preoperative anxiety and resulted in a smooth anesthetic induction compared to the use of midazolam or no intervention.
Methods:
This was a randomized, controlled, and blinded study conducted with children 3-8 years of age undergoing general anesthesia and elective outpatient surgery. Patients were assigned to one of three groups: Group 1 did not receive midazolam or clown presence; group 2 received 0.5 mg x kg(-1) oral midazolam 30 min before surgery up to a maximum of 15 mg; and group 3 had two specially trained clowns present upon arrival to the preoperative holding area and throughout operating room (OR) entrance and mask application for inhalation induction of anesthesia. The children were videotaped for later grading.
Results:
The clown group had a statistically significant lower modified-Yale Preoperative Anxiety Scale score in the preoperative holding area compared to the control and midazolam group. The clowns' effect on anxiety reduction continued when the children entered the OR but was equal at this point to the midazolam group. Upon application of the anesthesia mask no significant differences were detected between the groups.
Conclusions:
This study found that the use of preoperative medically trained clowns for children undergoing surgery can significantly alleviate preoperative anxiety. However, clowns do not have any effect once the anesthesia mask is introduced.
