Psychology versus medication for preanesthesia preparation of children: a randomized controlled trial

BACKGROUND: Reducing preoperative anxiety is important as inadequate preoperative management can potentially give rise to behavioral problems in the postoperative course, leading to incalculable quantitative and qualitative handicaps later in life. We compared preanesthetic administration of midazolam to a psychological strategy of walking the children through the operating room and playfully demonstrating anesthesia equipment. METHODS: Of 60 children initially randomized, 43 were ultimately evaluated along with their parents. Anxiety was assessed over defined times (T1-T5) using psychometric instruments. RESULTS: Primary outcome parameter: change in mean visual analogue scales (VAS) score before anesthesia (T1) to immediately before its induction (T3) in the pediatric patients. This change was significantly different (P=0.045) with a higher decrease of anxiety in the psychology group (mean - 0.13, 95% confidence interval -2.82 to -0.075) compared to the medication group (mean 1.39, 95% confidence interval 0.12 to 3.01). Secondary outcome parameters, State-Trait Anxiety Inventory (STAI): despite no significant intergroup difference in trait anxiety, state anxiety increased significantly in the medication but not in the psychology group (both true of children and parents). Modified Yale Preoperative Anxiety Scale (m-YPAS): the only significant decreases in parameters (for vocalization and emotional expressivity) were seen in the psychology group, and all parameters confirmed the finding of significantly greater anxiety in the medication group than in the psychology group at T3. CONCLUSIONS: All psychometric instruments used in this study indicated that our psychological strategy of preanesthesia preparation was capable of successfully reducing anxiety in paediatric patients and their parents.