Cartoon Distraction Alleviates Anxiety in Children During Induction of Anesthesia

• Published in: Anesthesia and analgesia Vol. 115; no. 5; pp. 1168 - 1173
• Main Authors: Lee, Jeongwoo, Lee, Jihye, Lim, Hyungsun, Son, Ji-Seon, Lee, Jun-Rae, Kim, Dong-Chan, Ko, Seonghoon
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.11.2012; Lippincott Williams & Wilkins
• Subjects: Age Factors; Anesthesia; Anesthesia - methods; Anesthesia - psychology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anxiety - prevention & control; Anxiety - psychology; Biological and medical sciences; Cartoons as Topic - psychology; Child; Child, Preschool; Female; Humans; Male; Medical sciences; Pilot Projects; Preoperative Care - methods; Preoperative Care - psychology; Prospective Studies; Videodisc Recording; Human; Anesthesia; Anxiety; Child
• ISSN: 0003-2999; 1526-7598; 1526-7598
• DOI: 10.1213/ANE.0b013e31824fb469

We performed this study to determine the beneficial effects of viewing an animated cartoon and playing with a favorite toy on preoperative anxiety in children aged 3 to 7 years in the operating room before anesthesia induction. One hundred thirty children aged 3 to 7 years with ASA physical status I or II were enrolled. Subjects were randomly assigned to 1 of 3 groups: group 1 (control), group 2 (toy), and group 3 (animated cartoon). The children in group 2 were asked to bring their favorite toy and were allowed to play with it until anesthesia induction. The children in group 3 watched their selected animated cartoon until anesthesia induction. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) and parent-recorded anxiety Visual Analog Scale (VAS) the night before surgery, in the preanesthetic holding room, and just before anesthesia induction. In the preanesthetic holding room, the group 2 mYPAS and parent-recorded anxiety VAS scores were significantly lower than those of groups 1 and 3 (mYPAS: P = 0.007; parent-recorded anxiety VAS: P = 0.02). In the operating room, the children in group 3 had the lowest mYPAS and parent-recorded anxiety VAS scores among the 3 groups (mYPAS: P < 0.001; parent-recorded anxiety VAS: P < 0.001). In group 3, the mYPAS and parent-recorded anxiety VAS scores of only 3 and 5 children were increased in the operating room compared with their scores in the preanesthetic holding room, whereas the anxiety scores of 32 and 34 children in group 1 and 25 and 32 children in group 2 had increased (P < 0.001). The number of children whose scores indicated no anxiety (mYPAS score <30) in the operating room was 3 (7%), 9 (23%), and 18 (43%) in groups 1, 2, and 3, respectively (P < 0.001). Allowing the viewing of animated cartoons by pediatric surgical patients is a very effective method to alleviate preoperative anxiety. Our study suggests that this intervention is an inexpensive, easy to administer, and comprehensive method for anxiety reduction in the pediatric surgical population.