Brown Erin, Vongkiatkajorn Krittika, Rich Vanessa, Kenardy Justin, Donaldson Alexandra, Paterson Rebecca, Graydon Cameron, Lee-Archer Paul
Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
Department of Anaesthesia and Pain Medicine, Queensland Children's Hospital, Brisbane, Australia.
Paediatr Anaesth. 2025 Jun 27. doi: 10.1111/pan.70006.
A general anesthetic can be an anxiety-provoking experience, and children who experience perioperative anxiety are more likely to have negative outcomes such as emergence delirium, increased analgesic requirements, and maladaptive behaviors. Parental presence at the induction of anesthesia can help reduce anxiety; however, only if the parent does not feel anxious themselves and can support their child in a positive way. The aim of this study was to test the efficacy of a short preparation video aimed at caregivers prior to the child's induction of anesthesia.
We conducted a randomized controlled trial of the Take5 video compared to standard care. The Take5 video was developed by pediatric anesthetists, child psychologists and a consumer panel of parents of children who had lived experience of surgery and anesthesia. The Take5 video is a 5-min, animated video that prepares caregivers for what to expect during the anesthetic induction. It also provides the caregiver with suggested behaviors that will positively support the child during the induction and psychological coping strategies to manage personal distress. Participants were randomized to the standard preparation group or the intervention group, which consisted of standard preparation plus the caregiver being shown the Take5 video in the preoperative waiting area prior to accompanying their child to the operating room. The primary outcome was child anxiety at induction measured using the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes were caregiver procedural behavior, child postoperative pain, emergence delirium, time to discharge, caregiver satisfaction and caregiver and child psychological wellbeing at 3 months.
One-hundred children and their caregivers were recruited to the trial. There was good to excellent inter-rater reliability with all of the observer scales (intraclass correlation coefficient = 0.81 for the mYPAS-SF). For the primary outcome of child anxiety at induction of anesthesia, there was good evidence for no difference between groups. For the secondary outcomes, the video intervention did not show any effect on parental behavior. There was a statistically significant difference in pain scores between groups, with children in the control group rated as having more pain on the Faces, Legs, Activity, Cry and Consolability (FLACC) scale (mean difference 0.6, 95% CI 0.04-1.16, p = 0.037). There was no difference shown in any of the other secondary outcomes including emergence delirium, time to discharge or caregiver satisfaction. There were also no differences in any of the 3-month psychological wellbeing outcomes: Child health-related quality of life, child behavioral difficulties or parent depression and anxiety scores. Despite this, in semistructured interviews, caregivers reported the video to be acceptable and beneficial, but many would have preferred to see it in the days prior to their child's procedure.
The Take5 video, shown to caregivers immediately prior to surgery, did not have any demonstrable effect on child anxiety at induction or on a range of postoperative outcomes; however, caregivers reported a perceived benefit to the child's induction experience. The results of this study did not show a measurable benefit of the Take5 video; however, this may be due to the timing of delivery. Providing this resource to families prior to coming into the hospital may be of benefit; however, further studies would be required to confirm this.
This study was registered in https://www.anzctr.org.au/ (ACTRN12621001337864; October 5, 2021).
全身麻醉可能是一种引发焦虑的体验，经历围手术期焦虑的儿童更有可能出现诸如苏醒期谵妄、镇痛需求增加和适应不良行为等负面结果。父母在麻醉诱导期在场有助于减轻焦虑；然而，前提是父母自身不感到焦虑且能够以积极的方式支持他们的孩子。本研究的目的是测试一段在儿童麻醉诱导前针对照顾者的简短准备视频的效果。
我们进行了一项将Take5视频与标准护理进行比较的随机对照试验。Take5视频由儿科麻醉师、儿童心理学家以及有手术和麻醉亲身经历的儿童家长组成的消费者小组共同制作。Take5视频是一个5分钟的动画视频，它让照顾者为麻醉诱导期间的预期情况做好准备。它还为照顾者提供了在诱导期间积极支持孩子的建议行为以及应对个人痛苦的心理应对策略。参与者被随机分为标准准备组或干预组，干预组包括标准准备以及在陪同孩子前往手术室之前，在术前等候区向照顾者展示Take5视频。主要结局是使用改良耶鲁术前焦虑量表简表（mYPAS - SF）测量的诱导期儿童焦虑。次要结局包括照顾者的手术行为、儿童术后疼痛、苏醒期谵妄、出院时间、照顾者满意度以及3个月时照顾者和儿童的心理健康状况。
100名儿童及其照顾者被纳入该试验。所有观察量表的评分者间信度良好至优秀（mYPAS - SF的组内相关系数 = 0.81）。对于麻醉诱导期儿童焦虑这一主要结局，有充分证据表明两组之间没有差异。对于次要结局，视频干预对父母行为没有任何影响。两组之间的疼痛评分存在统计学显著差异，对照组的儿童在面部、腿部、活动、哭闹和安慰性（FLACC）量表上的疼痛评分更高（平均差异0.6，95%置信区间0.04 - 1.16，p = 0.037）。在任何其他次要结局中均未显示出差异，包括苏醒期谵妄、出院时间或照顾者满意度。在3个月时的任何心理健康结局中也没有差异：儿童健康相关生活质量、儿童行为困难或父母的抑郁和焦虑评分。尽管如此，在半结构化访谈中，照顾者报告该视频是可以接受且有益的，但许多人希望在孩子手术前几天观看。
在手术前立即向照顾者展示的Take5视频，对诱导期儿童焦虑或一系列术后结局没有任何明显影响；然而，照顾者报告称该视频对孩子的诱导体验有一定益处。本研究结果未显示Take5视频有可衡量的益处；然而，这可能是由于视频播放的时间安排。在入院前向家庭提供此资源可能会有益处；然而，需要进一步研究来证实这一点。
本研究在https://www.anzctr.org.au/（ACTRN12621001337864；2021年10月5日）注册。
