Sablewski Armin, Jacobi Thorben, Walter Sebastian, Muhle Hiltrud, Kandzia Christian, Fazel Asita, Meinzer Andreas, Melchior Dithild-Angelika, Caliebe Amke, Kalab Michael, Becher Tobias, Lautenschläger Ingmar
Department of Anesthesiology and Intensive Care Medicine, University Hospital S-H, Kiel, Germany.
Department of Neuropediatrics, University Hospital S-H, Kiel, Germany.
Paediatr Anaesth. 2025 Jul;35(7):542-551. doi: 10.1111/pan.15105. Epub 2025 Apr 3.
Midazolam is commonly used and effective in reducing preoperative anxiety in children. Nonpharmacological interventions, such as video distraction, are also well established for alleviating preoperative anxiety in pediatric patients, particularly those treated in ambulatory settings.
To explore whether video distraction during anesthesia induction provides additional anxiety reduction in children premedicated with midazolam.
In this prospective randomized controlled trial, children aged 2-10 years scheduled for elective noncardiac surgery were premedicated with midazolam and randomly assigned to either a video group (n = 54) or a control group (n = 51). In the video group, videoclips were displayed as a distraction prior to anesthesia induction, while the control group received standard care. Anxiety was measured using the short form of the modified Yale Preoperative Anxiety Scale (mYPAS-SF). The primary endpoint was the change in mYPAS-SF scores between transfer to the operating theater and anesthesia induction (ΔmYPAS-SF). Secondary endpoints included emergence delirium, postoperative pain, and compliance during anesthesia induction. Character traits were assessed.
There was no additional anxiety reduction in the video group compared to the control group. The change in mYPAS-SF scores (median [interquartile range]) was 4.2 (-2.1, 16.7) in the control group and 4.16 (-2.1, 7.0) in the video group (p = 0.246). Similarly, there were no significant differences between the groups regarding compliance during anesthesia induction, emergence delirium, or postoperative pain. Compliance during anesthesia induction, emergence delirium, and postoperative pain was similar between the groups. Additional anxiety reduction through video distraction was observed in children with pronounced anxiety traits, including "General Phobia," "Separation," "Panic," and the overall "Total Phobia" score.
In our study, video distraction did not result in additional anxiety reduction in children premedicated with midazolam prior to anesthesia induction in a hospital setting. Certain children with specific personality traits may still benefit from this intervention.
Registry: German Clinical Trial Register; Registration number: DRKS00025411; Principal investigator's name: Armin Sablewski; Date of registration: February 15, 2022; https://drks.de/search/en/trial/DRKS00025411.
咪达唑仑常用于减轻儿童术前焦虑且效果良好。非药物干预措施，如视频分心，在减轻儿科患者术前焦虑方面也已得到充分证实，尤其是在门诊环境中接受治疗的患者。
探讨麻醉诱导期间的视频分心是否能为已用咪达唑仑进行术前用药的儿童进一步减轻焦虑。
在这项前瞻性随机对照试验中，计划接受择期非心脏手术的2至10岁儿童先用咪达唑仑进行术前用药，然后随机分为视频组（n = 54）或对照组（n = 51）。在视频组中，在麻醉诱导前播放视频片段以分散注意力，而对照组接受标准护理。使用改良耶鲁术前焦虑量表简表（mYPAS-SF）测量焦虑程度。主要终点是从转运至手术室到麻醉诱导期间mYPAS-SF评分的变化（ΔmYPAS-SF）。次要终点包括苏醒期谵妄、术后疼痛以及麻醉诱导期间的依从性。对性格特征进行评估。
与对照组相比，视频组并未进一步减轻焦虑。对照组mYPAS-SF评分的变化（中位数[四分位间距]）为4.2（-2.1，16.7），视频组为4.16（-2.1，7.0）（p = 0.246）。同样，两组在麻醉诱导期间的依从性、苏醒期谵妄或术后疼痛方面也无显著差异。两组在麻醉诱导期间的依从性、苏醒期谵妄和术后疼痛相似。在具有明显焦虑特征的儿童中观察到通过视频分心可进一步减轻焦虑，这些特征包括“一般恐惧症”、“分离焦虑”、“恐慌”以及总体“总恐惧症”评分。
在我们的研究中，在医院环境下，视频分心并未使术前已用咪达唑仑进行用药的儿童在麻醉诱导前进一步减轻焦虑。某些具有特定性格特征的儿童可能仍会从这种干预措施中受益。
注册机构：德国临床试验注册中心；注册号：DRKS00025411；首席研究员姓名：阿明·萨布列夫斯基；注册日期：2022年2月15日；网址：https://drks.de/search/en/trial/DRKS00025411 。
