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Which is good for pre-operative anxiety? Midazolam, video games or teaching with cartoons: A randomised trial
Bahar Sakızcı Uyar1, Reyhan Polat, Merve Bolat
1From the Department of Anesthesiology and Reanimation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Altındağ, Ankara, Turkey (BSU, RP, MB, AD).
Insights
Playing video games effectively reduced pre-operative anxiety in children undergoing surgery, unlike watching a cartoon. This active distraction method proved more valuable than passive techniques for managing pediatric anxiety.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Medical Education
Background:
- Pre-operative anxiety in children is linked to negative outcomes like anesthesia induction difficulties and postoperative behavioral changes.
- Effective anxiety reduction strategies are crucial for both pediatric patients and healthcare providers.
Purpose of the Study:
- To evaluate the impact of midazolam, video games, and a cartoon on pre-operative anxiety in children.
- To compare the efficacy of active distraction versus passive methods in managing pediatric anxiety.
Main Methods:
- A prospective randomized trial involving 138 children aged 5-8 years undergoing elective surgery.
- Anxiety levels were measured using the modified Yale Pre-operative Anxiety Scale (mYPAS) at baseline and post-intervention.
- Interventions included oral midazolam, playing video games, or watching an educational cartoon.
Main Results:
- Video game intervention significantly decreased pre-operative anxiety from baseline compared to midazolam and cartoon groups.
- No significant differences in anxiety levels were observed during mask induction across all groups.
- Cooperation during mask induction was similar for all interventions.
Conclusions:
- Active distraction through video games is an effective method for reducing pre-operative anxiety in children.
- Passive techniques, such as watching an educational video, were not effective in alleviating anxiety.
- Videogames offer a valuable tool for managing pediatric pre-operative anxiety.
Background:
Pre-operative anxiety in children has been associated with adverse clinical outcomes such as difficulty in anaesthesia induction, emergence delirium and negative postoperative behavioural changes. Therefore, pre-operative anxiety should be alleviated in both children and clinicians.
Objective:
We investigated the effect on pre-operative anxiety of premedication with midazolam, playing video games or watching a cartoon about anaesthesia.
Design:
A prospective randomised trial.
Setting:
Single-centre study performed between August 2018 and June 2019.
Patients:
We enrolled 138 patients aged 5 to 8 years undergoing elective surgery.
Interventions:
After evaluating baseline (T0) anxiety levels using the modified Yale Pre-operative Anxiety Scale (mYPAS) in the pre-operative holding area, 0.5 mg kg-1 oral midazolam was given to Group M, a tablet with videogame applications was given to Group T, and Group S watched the cartoon 'Şüko Is Being Operated'. mYPAS values were recorded a further three times: 20 min after the intervention (T1), while entering the operating room (T2), and during mask induction of anaesthesia (T3).
Main Outcome Measures:
The primary endpoint was the change in children's anxiety levels from baseline. The secondary endpoint was cooperation during mask induction.
Results:
The baseline mYPAS scores were comparable (40.7, 42.6 and 40.7 in groups M, S and T respectively). The mean mYPAS scores at T1 were 32.6, 34.7, 26.8 and at T2 were 38.6, 42.7, 35 in groups M, S and T, respectively. There were significant differences between groups S and T at T1 and T2 (P < 0.001, P = 0.010). A significant decrease was found in Group T compared with both groups M and S from T0 to T1 (P = 0.002). mYPAS values at T3 were 38.3, 43.7, 39.5 in groups M, S and T, respectively, with no difference between the groups (P = 0.224). Mask acceptance scores were similar in all groups (P = 0.912).
Conclusions:
The passive teaching technique of watching a video for reducing anxiety levels was not effective. However, active distraction with videogames was found to be a valuable method to reduce pre-operative anxiety.
Trial Registration:
ClinicalTrials.gov identifier: NCT03530670.
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