Effect of interactive, multimedia-based home-initiated education on preoperative anxiety inchildren and their parents: a single-center randomized controlled trial

Huiyan Hou, Xie Li, Yun'an Song, Yingying Ji, Menglian Sun, Dan Wang, Jiali Jiao, Jifang Qu, Hongbin Gu, Huiyan Hou, Xie Li, Yun'an Song, Yingying Ji, Menglian Sun, Dan Wang, Jiali Jiao, Jifang Qu, Hongbin Gu

Abstract

Background: Anesthesiologists need to appreciate the impact of preoperative anxiety in children. The present study aimed to explore whether interactive multimedia-based home-initiated interventions could effectively relieve preoperative anxiety in pediatric patients.

Methods: In this prospective study, we compared preoperative anxiety between two groups of children aged 4-9 years. Children in the control group received a question-and-answer (Q&A) introduction, and children in the intervention group received multimedia-based home-initiated preoperative education using comic booklets, videos, and coloring game books. Differences in anxiety between the two groups were evaluated by the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) at four time points: in the ophthalmology outpatient clinic before intervention as the baseline (T0); in the preoperative waiting area (T1); at the time of separating from their parents and moving to the operating room (T2); and at the time of anesthesia induction (T3). Parental anxiety was assessed by the Self-rating Anxiety Scale (SAS) and Visual Analog Scale (VAS) at T0 and T2. Other related information was collected by questionnaire.

Results: Eighty-four children who underwent pediatric strabismus in our center between November 2020 and July 2021 were included in this study. An intention-to-treat (ITT) analysis was performed on data from 78 enrolled children. Children in the intervention group exhibited lower m-YPAS-SF scores at T1, T2, and T3 than those in the control group (all p < 0.001). By using a mixed-effect model with repeated measurement (MMRM) after adjusting the m-YPAS score at T0 as a covariate, the interventional effect in terms of themYPAS-SF score was also significant over time (p < 0.001). The percentage of children with perfect induction compliance (ICC = 0) in the intervention group was significantly higher than that in the control group [18.4% vs. 7.5%], and poor induction compliance (ICC>4) was lower (2.6% vs. 17.5%, p = 0.048). The mean parental VAS score at T2 in the intervention group was significantly lower than that in the control group (p = 0.021).

Conclusions: Interactive multimedia-based home-initiated intervention could reduce preoperative anxiety in children and improve the quality of anesthesia induction based on ICC scores, which may in turn impose a positive impact on parental anxiety.

Keywords: Children; Interactive; Multimedia-based; Parents; Preoperative anxiety.

Conflict of interest statement

None.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Study flow diagram. Note: Children in the intervention group received preoperative educational information through a comic booklet, video, and coloring game book, and children in the control group received preoperative educational information by Q & A. mYPAS-SF, modified Yale Preoperative Anxiety Scale-Short Form; SAS, Self-rating Anxiety Scale; VAS, Visual Analog Scale; ICC, The Induction Compliance Checklist
Fig. 2
Fig. 2
Flow diagram of the patients
Fig. 3
Fig. 3
Trends of children’s anxiety. Note: mYPAS-SF: the modified Yale Preoperative Anxiety Scale-Short-Form; T0 = baseline, in the ophthalmology outpatient clinic before any intervention; T1 = in the preoperative waiting area; T2 = at the time of separating from the parents and moving to the operating room; T3 = at the time of anesthesia induction. Mixed effect analysis, group comparisons *p 

References

    1. Yang Y, et al. Effects of advance exposure to an animated surgery-related picture book on preoperative anxiety and anesthesia induction in preschool children: a randomized controlled trial. BMC Pediatr. 2022;22(1):92. doi: 10.1186/s12887-022-03136-1.
    1. Ahmed MI, et al. Preoperative anxiety in children risk factors and non-pharmacological management. Middle East J Anaesthesiol. 2011;21(2):153–64.
    1. Getahun AB, et al. Magnitude and factors Associated with preoperative anxiety among Pediatric Patients: cross-sectional study. Pediatr Health Med Ther. 2020;11:485–94. doi: 10.2147/PHMT.S288077.
    1. Arze S, et al. Incidence and risk factors of preoperative anxiety in spanish-speaking children living in a spanish-speaking country. Paediatr Anaesth. 2020;30(7):792–8. doi: 10.1111/pan.13899.
    1. Kain ZN, et al. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651–8. doi: 10.1542/peds.2005-2920.
    1. Capurso M, Ragni B. Psycho-educational preparation of children for anaesthesia: a review of intervention methods. Patient Educ Couns. 2016;99(2):173–85. doi: 10.1016/j.pec.2015.09.004.
    1. Zainal Abidin H, et al. Postoperative maladaptive behavior, preoperative anxiety and emergence delirium in children Undergone General Anesthesia: a narrative review. Glob Pediatr Health. 2021;8:2333794X211007975.
    1. Heikal S, Stuart G. Anxiolytic premedication for children. BJA Educ. 2020;20(7):220–5. doi: 10.1016/j.bjae.2020.02.006.
    1. Finley GA, et al. High levels of impulsivity may contraindicate midazolam premedication in children. Can J Anaesth. 2006;53(1):73–8. doi: 10.1007/BF03021530.
    1. Bumin Aydin G, et al. The effect of play distraction on anxiety before premedication administration: a randomized trial. J Clin Anesth. 2017;36:27–31. doi: 10.1016/j.jclinane.2016.04.044.
    1. Agbayani CG, Fortier MA, Kain ZN. Non-pharmacological methods of reducing perioperative anxiety in children. BJA Educ. 2020;20(12):424–30. doi: 10.1016/j.bjae.2020.08.003.
    1. Manyande A et al. Non-pharmacological interventions for assisting the induction of anaesthesia in children.Cochrane Database Syst Rev, 2015(7): p.CD006447.
    1. Jin Y, et al. Self-produced audio-visual animation introduction alleviates preoperative anxiety in pediatric strabismus surgery: a randomized controlled study. BMC Ophthalmol. 2021;21(1):163. doi: 10.1186/s12886-021-01922-6.
    1. Liu PP, et al. The effectiveness of transport in a toy car for reducing preoperative anxiety in preschool children: a randomised controlled prospective trial. Br J Anaesth. 2018;121(2):438–44. doi: 10.1016/j.bja.2018.02.067.
    1. Scarano F et al. Application of a non-pharmacological technique in addition to the pharmacological protocol for the management of children’s preoperative anxiety: A 10 years’ experience.Pediatr Med Chir, 2021. 43(1).
    1. Rasti-Emad-Abadi R, et al. The Effects of preanesthetic parental Presence on preoperative anxiety of children and their parents: a Randomized Clinical Trial Study in Iran. Iran J Nurs Midwifery Res. 2017;22(1):72–7. doi: 10.4103/ijnmr.IJNMR_178_14.
    1. Kain ZN, et al. Parental presence during induction of anesthesia: physiological effects on parents. Anesthesiology. 2003;98(1):58–64. doi: 10.1097/00000542-200301000-00013.
    1. Jenkins BN, et al. Development of a short version of the modified Yale preoperative anxiety scale. Anesth Analg. 2014;119(3):643–50. doi: 10.1213/ANE.0000000000000350.
    1. Kain ZN, et al. The Yale preoperative anxiety scale: how does it compare with a “gold standard”? Anesth Analg. 1997;85(4):783–8. doi: 10.1213/00000539-199710000-00012.
    1. Gil Mayo D et al. Parental Presence during Induction of Anesthesia Improves Compliance of the Child and Reduces Emergence Delirium.Eur J Pediatr Surg, 2021.
    1. Zung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971;12(6):371–9. doi: 10.1016/S0033-3182(71)71479-0.
    1. Kindler CH, et al. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg. 2000;90(3):706–12. doi: 10.1097/00000539-200003000-00036.
    1. Bumin Aydın G, Sakızcı B, Uyar Mothers Level of Education and Preoperative Informative Story Book Reading helps reduce preoperative anxiety in children in Turkey. J Pediatr Nurs. 2021;60:e19–e23. doi: 10.1016/j.pedn.2021.02.012.
    1. Cordray H, Patel C, Prickett KK. Reducing children’s preoperative fear with an Educational Pop-up Book: a Randomized Controlled Trial. Otolaryngol Head Neck Surg. 2022;167(2):366–74. doi: 10.1177/01945998211053197.
    1. Hamza Taha SM, Hassan El-Sayed RE. Effect of an Educational Comic Story about Preoperative Orientation on information and anxiety level of children undergoing surgery. Clin Nurs Res. 2021;30(6):771–9. doi: 10.1177/1054773821994851.
    1. Kassai B, et al. Introduction of a paediatric anaesthesia comic information leaflet reduced preoperative anxiety in children. Br J Anaesth. 2016;117(1):95–102. doi: 10.1093/bja/aew154.
    1. Li HC, Lopez V, Lee TL. Psychoeducational preparation of children for surgery: the importance of parental involvement. Patient Educ Couns. 2007;65(1):34–41. doi: 10.1016/j.pec.2006.04.009.
    1. Hilly J, et al. Preoperative preparation workshop reduces postoperative maladaptive behavior in children. Paediatr Anaesth. 2015;25(10):990–8. doi: 10.1111/pan.12701.
    1. Kim J, et al. A systematic review of technology-based preoperative preparation interventions for child and parent anxiety. Can J Anaesth. 2019;66(8):966–86. doi: 10.1007/s12630-019-01387-8.
    1. Fortier MA, et al. Children’s desire for perioperative information. Anesth Analg. 2009;109(4):1085–90. doi: 10.1213/ane.0b013e3181b1dd48.
    1. Nair T, et al. Home-Initiated-Programme-to-prepare-for-Operation: evaluating the effect of an animation video on peri-operative anxiety in children: a randomised controlled trial. Eur J Anaesthesiol. 2021;38(8):880–7.
    1. Eijlers R, et al. Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: a randomised controlled trial. Eur J Anaesthesiol. 2019;36(10):728–37. doi: 10.1097/EJA.0000000000001059.
    1. Fincher W, Shaw J, Ramelet AS. The effectiveness of a standardised preoperative preparation in reducing child and parent anxiety: a single-blind randomised controlled trial. J Clin Nurs. 2012;21(7–8):946–55. doi: 10.1111/j.1365-2702.2011.03973.x.

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