Effect of Preoperative Education on Behaviour of Children during Induction of Anaesthesia: A Randomised Clinical Trial of Efficacy

Abstract

In this randomised prospective study we aimed to evaluate whether preoperative anaesthetic education delivered to children on the day of surgery reduces anxiety behaviour during induction of anaesthesia. One hundred children, six to 15 years of age, undergoing general anaesthesia for ambulatory surgery were allocated at random to a preoperative education group (n=50) or a control group (n=50). The main outcomes were behaviour score, self-reporting of satisfaction score and identification of the stage when children felt most fearful. Data from all 100 participants were analysed. There was no difference in behaviour score at induction or satisfaction score between the groups. Eighteen percent in the intervention group reported no fear preoperatively vs 10% in the control group. Intravenous induction failed in nine out of 38 children in the intervention group (23.7%) compared to five out of 40 in the control group (12.5%). When intravenous induction failed, eight out of nine (89%) of the intervention group remained cooperative during gas induction compared to two out of five (40%) of the control group. Preoperative education delivered on the day of surgery did not reduce anxiety behaviour in children during intravenous induction of anaesthesia, but did reduce anxiety during subsequent inhalational induction.

Refining guidelines for the care of paediatric perioperative patients in a rural health care facility

“…Increased anxiety reduces cooperation during induction of anaesthesia and is associated with the increased likelihood of emergence delirium in the Post Anaesthesia Care Unit (PACU) 9 . Furthermore, preoperative anxiety has adverse clinical and maladaptive behavioural effects 9,10 . Clinical effects manifest as increased post-operative pain and analgesia consumption 7,11 .…”

“…Clinical effects manifest as increased post-operative pain and analgesia consumption 7,11 . Maladaptive behavioural effects include nightmares, separation anxiety, nocturnal enuresis, sleeping problems, feeding difficulties, withdrawal and apathy 8,10 .…”

A mixed‐method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery

“…After quality appraisal, five experimental studies were excluded due to high selection bias (Cuzzocrea et al, 2013;Dai, Li, & Shi, 2016;Hatava, Olsson, & Lagerkranser, 2000;Hee et al, 2012;Lyu, Pang, & Liang, 2016), two due to high attrition bias (Felder-Pulg et al, 2003;Margolis et al, 1998). One qualitative study (Tabrizi et al, 2015) was judged as having low quality and thus was excluded.…”

“…During recent years, much work has been undertaken to investigate new PPP programmes across the globe. The approaches taken to PPPs include the use of leaflets (Setoodeh, Sharif, Faramarzi, & Tabatabaee, 2010), story books (Tunney & Boore, 2013), videos (Kain et al, 2007), therapeutic play (Li, Lopez, & Lee, 2007b), family-centred programmes (O' Conner-Von, 2008), interactive applications (Hee, Lim, Tan, Bao, & Loh, 2012) and web-based programmes (Kain, Fortier, Chorney, & Mayes, 2015). Yet the effectiveness of some strategies remains uncertain.…”

Reducing preoperative anxiety with Child Life preparation prior to intravenous induction of anesthesia: A randomized controlled trial

“…The inhalational technique has traditionally been the predominant practice for inducing anesthesia in children, and most studies evaluating preoperative anxiety have been conducted with this approach. There is relatively little data on the effect of interventions to reduce anxiety prior to IV cannulation in the operating room for induction of anesthesia: Studies of preoperative education, audio/visual distraction, and the use of different premedications have not yielded clear recommendations. The increasing popularity and potential benefits of total IV anesthesia necessitate IV cannulation in the awake child, though children may be more anxious before IV induction compared with inhalational induction of anesthesia .…”