From the Department of Anesthesiology and Pain, Irmandade da Santa Casa de Misericordia de São Paulo (DOC); Department of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (JEV); Faculdade Pernambucana de Saúde (LCL); and Santa Casa de São Paulo School of Medical Sciences (LPS, RAPS, LASTM).
Eur J Anaesthesiol. 2017 Mar;34(3):169-175. doi: 10.1097/EJA.0000000000000589.
Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial.
OBJECTIVE(S): To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction.
Randomised clinical trial.
A tertiary care teaching hospital.
In total, 84 children (aged 4 to 8 years; American Society of Anesthesiologists I and II) undergoing minor-to-moderate elective surgical procedures and their parents/guardians.
Children were randomised into four groups: control group, in which the parent/guardian was verbally informed about the anaesthetic procedure; the informed group, in which the parent/guardian was also provided with an information leaflet about the anaesthetic procedure; the smartphone group, in which the parent/guardian was verbally informed and the child received a smartphone application to play with while in the holding area before entering the operating room and the smartphone and informed group, in which the parent/guardian also received an information leaflet and the child, a smartphone application to play with while in the holding area before entering the operating room.
Children's anxiety at two time points: in the holding area of the surgical centre and in the operating room during induction of anaesthesia by facemask.
Median (IQR) anxiety levels were greater at time point operating room for children in the control group (55.0; range: 30.0 to 68.4) than in the other groups: informed group, 28.4 (23.4 to 45.0); smartphone group, 23.4 (23.4 to 30.0); smartphone and informed group, 23.4 (23.4 to 25.9).
The behavioural distraction strategies using smartphones were effective in preventing an increase in children's anxiety during anaesthesia induction.
clinicaltrials.gov identifier: NCT02246062.
术前焦虑会对儿童的麻醉和手术体验产生负面影响，并导致术后并发症，如苏醒期谵妄和行为改变。使用缓解心理压力的替代疗法进行非药物治疗，与药物治疗一样，可以减轻儿童的焦虑。然而，它们作为一种有效的减轻儿童焦虑的策略的有效性仍然存在争议。
验证向父母/监护人和儿童分别提供传单和智能手机应用分心的非药物策略是否能有效预防麻醉诱导期间儿童的焦虑。
随机临床试验。
三级教学医院。
共 84 名（年龄 4 至 8 岁；美国麻醉医师协会 I 和 II 级）接受小到中度择期手术的儿童及其父母/监护人。
儿童随机分为四组：对照组，父母/监护人仅口头告知麻醉程序；知情组，父母/监护人还提供麻醉程序的信息传单；智能手机组，父母/监护人口头告知，儿童在进入手术室前在等候区使用智能手机应用程序；智能手机和知情组，父母/监护人还提供信息传单，儿童在进入手术室前在等候区使用智能手机应用程序。
儿童在两个时间点的焦虑程度：手术中心等候区和面罩麻醉诱导时的手术室。
在手术室，对照组儿童（中位数[IQR]：55.0；范围：30.0 至 68.4）的焦虑程度高于其他组：知情组：28.4（23.4 至 45.0）；智能手机组：23.4（23.4 至 30.0）；智能手机和知情组：23.4（23.4 至 25.9）。
使用智能手机的行为分散策略可有效预防麻醉诱导期间儿童焦虑的增加。
clinicaltrials.gov 标识符：NCT02246062。
