Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery

BACKGROUND Preschoolers become anxious when they are about to undergo anesthesia and surgery,warranting the development of more appropriate and effective interventions.AIM To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery.METHODS One hundred and sixteen preschool-aged children were selected and assigned to the drug(n=37),intervention(n=40),and control(n=39)groups.All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation.The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments.The control group received no intervention.The modified Yale Preoperative Anxiety Scale was used to evaluate the children’s anxiety level on the day before surgery(T0),before leaving the preoperative preparation room(T1),when entering the operating room(T2),and at anesthesia induction(T3).Compliance during anesthesia induction(T3)was evaluated using the Induction Compliance Checklist(ICC).Changes in mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were also recorded at each time point.RESULTS The anxiety scores of the three groups increased variously at T1 and T2.At T3,both the drug and intervention groups had similar anxiety scores,both of which were lower than those in the control group.At T1 and T2,MAP,HR,and RR of the three groups increased.The drug and control groups had significantly higher MAP and RR than the intervention group at T2.At T3,the MAP,HR,and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group.Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction(T3),both of which were higher than those of the control group.CONCLUSION Combining static cartoons with dynamic virtual environments as effective as medication,specifically midazolam,in reducing preoperative anxiety and fear in preschool-aged children.This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.

Can acupuncture therapy reduce preoperative anxiety?A systematic review and meta-analysis

Background:Acupuncture therapy has shown promise for effectively relieving preoperative anxiety.Nevertheless,previous findings from randomized controlled trials(RCTs)are inconsistent and must be examined in detail.Objective:This study systematically evaluates the efficacy and safety of acupuncture therapy for preoperative anxiety as well as the quality of evidence supporting this application.Search strategy:The China National Knowledge Infrastructure Database,Wanfang Data Journal Database,Chinese Biomedical Literature Database,Chongqing VIP,Embase,Pub Med and Cochrane Library Databases were queried from their inception to 19,February 2020,using keywords such as“acupuncture therapy,”“preoperative”and“anxioty.”Manual searches expanded the search breadth and included conference abstracts and other reference lists.Inclusion criteria:RCTs were included in the current study if they contained a comparison between a group of anxiety patients that received acupuncture therapy and a control group that received sham acupuncture.Data extraction and analysis:Literature was reviewed,and various articles were selected using the Note Express 3.2.0 software.Two researchers independently screened and extracted data and evaluated the risk of bias in the included studies.The Rev Man 5.3 software was used for data aggregation and the Grades of Recommendation,Assessment,Development and Evaluation(GRADE)assessment was used to evaluate the quality of the study outcomes.Results:Twelve studies were included in the review,containing a total of 916 patients.Meta-analysis showed that,compared with the control group,patients who received acupuncture therapy had reduced State-Trait Anxiety Inventory Scale(STAI-S)score(mean difference[MD]=–9.07,95%confidence interval[CI][–13.19 to–4.96],P<0.0001)and Visual Analogue Scale(VAS)score(MD=–1.37,95%CI[–2.29 to–0.45],P=0.003).However,for the Hamilton Anxiety Scale(HAMA)score,there was no difference between the two groups(MD=–3.98,95%CI[–12.89 to 4.92],P=0.38).Further,the GRADE assessment demonstrated that the STAI-S was of moderate quality,the VAS of low quality and the HAMA of very low quality.Conclusion:Acupuncture therapy may be able to decrease anxiety in preoperative patients,but the results need to be further verified due to the small sample sizes and the low quality of evidence to date.

The Association between Preoperative Parental Anxiety and Emergence Agitation in Preschoolers

Introduction: The preoperative distress and anxiety experienced by preschoolers are associated with an increased incidence of troubled recovery from anesthesia. However, influences of parental anxiety on children at different stages of the surgical processes are not clear. The aim of this study was to evaluate any existing association between preoperative parental anxiety and emergence agitation in a pediatric surgery population. Materials and Methods: A total of 60 children ASA class I or II, aged 3 - 12 years old, undergoing adenotonsillectomy with sevoflurane, were included in the study. Before surgery, we used State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety. Emergence agitation of the children was assessed with Watcha scale and recorded every 10 min of first 30 min of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate their satisfaction, post operative pain and any side effect observed in the children. Results: Preoperatively, the mean STAI-S scores of mothers were significantly higher than those of fathers (p 0.05). The children had the highest agitation scores at 10th postoperative minutes with an incidence of 73.9%. There was no correlation between parental anxiety and emergence agitation. Logistic regression analysis showed that low educational level of the parent was the only independent factor for state anxiety (OR: 8.96, 95% CI: 1.50 - 40.35, p = 0.030). Discussion: In this study, we observed that education level of the parents might affect their preoperative anxiety. The factors influential in parental anxiety were not correlated with pediatric emergence agitation in this study.