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Childhood preoperative anxiolysis: Is sedation and distraction better than either alone? A prospective randomized
Chrystelle Sola1, Audrey Lefauconnier1, Sophie Bringuier1
1Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Insights
Midazolam and video distraction effectively manage preoperative anxiety in children. Combining midazolam with video distraction did not offer additional benefits over using either strategy alone for pediatric anxiolysis.
Area of Science:
- Pediatric Anesthesia
- Anesthesiology
- Child Psychology
Background:
- Preoperative anxiety in children is a significant concern in pediatric anesthesia.
- Effective management strategies are crucial for a positive surgical experience.
- This study evaluated three distinct approaches to reduce preoperative anxiety in children.
Purpose of the Study:
- To assess the efficacy of midazolam premedication, midazolam with video distraction, and video distraction alone for childhood preoperative anxiolysis.
- To compare the effectiveness of these strategies in managing preoperative anxiety.
- To evaluate secondary outcomes including emergence delirium, postoperative pain, and parental satisfaction.
Main Methods:
- A prospective randomized study involving 135 children aged 2-12 years.
- Children were assigned to one of three groups: midazolam, midazolam + video, or video alone.
- Preoperative anxiety was measured using the Modified Yale Preoperative Anxiety Scale (mYPAS) and Visual Analog Anxiety Scale (VAS-Anxiety).
Main Results:
- All three strategies effectively controlled preoperative distress.
- No significant difference in anxiety reduction was observed between the groups (mYPAS mean change: midazolam group 2.4, midazolam+video group -1.0, video group 1.4).
- Emergence delirium, postoperative pain, analgesic consumption, and parental satisfaction were comparable across all groups.
Conclusions:
- Both pharmacological premedication (midazolam) and non-pharmacological video distraction are effective for controlling preoperative childhood anxiety.
- The combination of midazolam and video distraction did not provide superior anxiolytic effects compared to either intervention used individually.
- These findings support the use of either midazolam or video distraction as standalone strategies for pediatric preoperative anxiety management.
Background:
Preoperative anxiety management receives special attention in pediatric anesthesia. Different pharmacological and nonpharmacological techniques can be employed. This study was designed to assess three different strategies for childhood preoperative anxiolysis: midazolam premedication, midazolam in combination with portable Digital Video-Disk player, or video distraction strategy alone.
Methods:
In this prospective randomized study, children aged 2-12 years were assigned to one of the three study groups. The primary outcome was a change in preoperative children's anxiety, from baseline (before transfer to the preanesthetic holding area) to separation from parents, assessed by the Modified Yale Preoperative Anxiety Scale (mYPAS) and the Visual Analog Anxiety Scale (VAS-Anxiety). Delirium emergence, postoperative pain, and parental satisfaction were also collected.
Results:
One hundred and thirty-five patients were enrolled. The three preventive strategies allowed control of preoperative distress. Within the three study groups, no significant change was objectified in the anxiety level from baseline to separation from parents (mean change in mYPAS midazolam group: 2.4 95% CI [-1.7 to 6.3]; midazolam+Digital Video-Disk group: -1.0 95% CI [-5.9 to 3]; and Digital Video-Disk group: 1.4 95% CI [-4 to 6.7]). Comparison of change in preoperative children's anxiety between the groups did not show any difference. Emergence delirium, postoperative pain scores, and analgesic consumption were similar between the groups and parents' satisfaction was excellent.
Conclusion:
Both pharmacological premedication and video distraction are effective strategies for controlling preoperative childhood anxiety. The combination of midazolam and Digital Video-Disk player was not better than either alone.
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