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Non-pharmacological Interventions for Preoperative Anxiety in Children: A Systematic Review and Network Meta-Analysis
Haotian Chen1, Jianhao Zhang1, Sainan Li1
1Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Psychological and digital health interventions, particularly combined parental presence during anesthesia induction and video games, are most effective for reducing children's preoperative anxiety. Further research is recommended.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Digital Health Interventions
Background:
- Preoperative anxiety affects up to 60% of children, leading to adverse outcomes.
- Non-pharmacological interventions show promise, but comparative efficacy is unclear.
Purpose of the Study:
- To compare the efficacy of various non-pharmacological interventions for reducing preoperative anxiety in children.
- To identify the most effective interventions through network meta-analysis.
Main Methods:
- Systematic review and network meta-analysis (NMA) of 36 randomized controlled trials (RCTs) including 3182 pediatric patients.
- Searched 12 databases from inception to March 31, 2024, adhering to PRISMA 2020 guidelines.
- Primary outcome: change in preoperative anxiety severity; ranking via Surface Under the Cumulative Ranking Curve (SUCRA).
Main Results:
- Psychological + digital health interventions ranked highest in efficacy compared to control groups.
- Combined parental presence during anesthesia induction and video games (PPIA + VG) showed significant benefits over most other interventions.
Conclusions:
- Psychological + digital health interventions, especially PPIA + VG, appear most effective for pediatric preoperative anxiety.
- Further RCTs are needed to confirm the efficacy of different non-pharmacological approaches.
Aims:
This study aimed to compare the efficacy of non-pharmacological interventions in children with preoperative anxiety.
Background:
It is estimated that preoperative anxiety affects up to 60% of children which is associated with both immediate and long-term adverse outcomes. Several non-pharmacological interventions have been demonstrated to be effective, but further research is necessary to determine which is the most effective.
Design:
This study was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist.
Methods:
We searched randomised controlled trials in twelve databases from which inception to March 31, 2024. The primary outcome was the severity of preoperative anxiety change from the baseline to the endpoint which is usually before the anaesthesia induction. Within the frequentist framework, a random-effects network meta-analysis (NMA) was used to compare the primary outcomes. The surface under the cumulative ranking curve (SUCRA) was used to rank each intervention separately. Subgroup and sensitivity analyses were carried out for the primary outcomes.
Results:
A total of 36 randomised controlled trials (RCTs) with 3182 paediatric patients were included. Based on the results, psychological + digital health intervention was significantly more effective than control groups and ranked highest. Combined parental presence during induction anaesthesia and video games (PPIA + VG) had significant benefits compared to almost all other interventions with the highest rank.
Conclusion:
Psychological + digital health interventions, especially PPIA + VG, may be the most effective non-pharmacological interventions for reducing preoperative anxiety in children. It is necessary to conduct more RCTs to evaluate the efficacy of different non-pharmacological interventions.
Relevance To Clinical Practice:
Non-pharmacological interventions can effectively improve preoperative anxiety in children.
Patient Or Public Contribution:
No patient or public contribution applies to this work.
Trial Registration:
PROSPERO CRD42024509512 (https://www.crd.york.ac.uk/PROSPERO/).
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