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The effect of active distraction compared to midazolam in preschool children in the perioperative setting: A
Michelle M Levay1, Megan K Sumser1, Kristen M Vargo2
1Office of Nursing Research & Innovation, USA; Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Insights
Active distraction using a tablet effectively reduced preoperative anxiety in preschool children, matching midazolam
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
Background:
- Preoperative anxiety is common in preschool children undergoing surgery.
- Pharmacological methods like midazolam are often used but can have side effects.
- Non-pharmacological alternatives are sought to manage anxiety and improve patient experience.
Purpose of the Study:
- To compare the efficacy of active distraction (tablet use) versus midazolam in reducing preoperative anxiety in preschool children.
- To evaluate differences in emergence delirium, sedation/agitation, and length of stay between the two groups.
Main Methods:
- A randomized controlled trial involving 99 preschool children undergoing elective surgery.
- Two groups: active distraction with a tablet (n=52) and midazolam administration (n=47).
- Anxiety, delirium, and agitation were assessed using validated scales; length of stay was recorded.
Main Results:
- No significant difference in preoperative anxiety, emergence delirium, or sedation/agitation scores between the tablet and midazolam groups.
- Children in the active distraction (tablet) group experienced a significantly shorter length of stay (p=0.021).
Conclusions:
- Active distraction with a tablet is a safe and effective non-pharmacological alternative to midazolam for managing preoperative anxiety in preschool children.
- This approach offers comparable anxiolytic effects to midazolam without associated side effects and potentially reduces hospital length of stay.
Purpose:
The primary purpose of this study was to compare the effect of active distraction to midazolam as a non-pharmacological method of reducing preoperative anxiety in preschool children. A secondary purpose was to compare emergence delirium, sedation/agitation, and length of stay between groups.
Design And Methods:
Preschool children (N = 99) scheduled for elective surgery participated in this 2-group randomized controlled trial: the active distraction (tablet) group (n = 52) had unlimited playtime with a tablet and the midazolam group (n = 47) were medicated approximately 10 min before mask induced anesthesia. Data were collected using the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium scale, and Richmond Agitation Sedation Score. Length of stay (LOS) was measured in minutes from PACU admission to discharge. Wilcoxon rank sum, Pearson's chi square, and Fischer's exact tests were used in analysis.
Results:
Preschool children (3-5 years old), predominantly male (61%) and White (85%) presented for ear, nose, throat, ophthalmology, urology, and general surgery at a pediatric surgical center within a large Midwestern hospital. There was no significant difference in anxiety, emergence delirium, or sedation/agitation scores between midazolam and tablet groups. Children assigned to the tablet group had shorter LOS (p = 0.021).
Conclusion:
Active distraction with a tablet as an anxiolytic was as effective as midazolam for pre-school aged children with no side effects and reduced length of stay.
Practice Implications:
Preoperatively, non-pharmacological methods such as active distraction with a tablet should be considered for preschool children as an alternative to medication.
