If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Effective interventions to reduce pre-operative anxiety in children is an urgent need.
•
The effect of two distraction strategies (music or animation) on preoperative anxietyin children is unknown.
•
The music or animation strategies can significantly reduce preoperative anxiety of children.
•
Both strategies are easy to operate in clinical practice.
•
Animation intervention was welcomed by most children.
Abstract
Purpose
Music and animation are the most common and affordable distraction strategies to reduce preoperative anxiety in children; however, their effects are inconsistent. This study aimed to examine the effectiveness of two distraction strategies (music or animation) in reducing preoperative anxiety in children.
Design and methods
In this randomized controlled trial, 183 children who underwent surgery were divided into music, animation, and control groups using a single-blind block randomized design. Children in the control group underwent routine preoperative visits. Meanwhile, the children in the intervention groups could choose their favorite music and cartoons as intervention content. Study outcomes included anxiety levels, degree of cooperation, heart rate, and blood pressure. Data were collected before entering the operating room, entering the operating room, and before the induction of anesthesia; only the degree of cooperation was collected before the induction of anesthesia.
Results
Only animation significantly reduced preoperative anxiety in the children (P < 0.05) upon entering the operating room. Both music and animation reduced the level of preoperative anxiety before induction of anesthesia; however, there was no significant difference between them (P > 0.05). The induction compliance score was significantly lower in the music and animation groups than in the control group (P < 0.05). Heart rates differed significantly between the three groups from before entering the operating room to before induction of anesthesia. Children in the control group had the highest systolic blood pressure upon entering the operating room (P < 0.05).
Conclusions
Music and animation strategies can significantly reduce preoperative anxiety in children and improve surgical cooperation during anesthesia induction.
Surgery, as a threatening stressor, often leads to strong psychological stress reactions in surgical patients before surgery, the most typical of which is anxiety (
). Children are often afraid and nervous before surgery because they are separated from their parents and face the unfamiliar environment of the operating room alone (
). They react to this experience with behaviors typical of their age by being resistant and fearful of unfamiliar surroundings and individuals, crying, and refusing to enter the operating room(
). Furthermore, preoperative anxiety in children is significantly related to adverse postoperative physiological and psychological changes, such as delirium during recovery from anesthesia, postoperative pain, and sleep disturbance, and has a serious negative impact on their study and life (e.g., timidity, nocturia, among others), even for several years (
) conducted a virtual reality exposure (VRE) before elective day surgery to reduce children's anxiety and pain through a randomized, single-blind trial. The results showed no differences between the VRE and control groups in self-reported anxiety, pain, emergence delirium, or parental anxiety. Moreover, several studies have explored the efficacy of psychological interventions in reducing preoperative anxiety in children undergoing surgery (
Perioperative anxiety and stress in children undergoing congenital cardiac surgery and their parents: Effect of brief intervention-a randomized control trial.
Journal of Cardiothoracic and Vascular Anesthesia.2019; 33: 1244-1250
) adopted relaxation-guided imagery to reduce both preoperative anxiety and postoperative pain in a sample of 60 children (6–12 years old) undergoing minor surgery, and the results suggested that relaxation-guided imagery reduces preoperative anxiety and postoperative pain in children. Through toys and video games, researchers (
Perioperative anxiety and stress in children undergoing congenital cardiac surgery and their parents: Effect of brief intervention-a randomized control trial.
Journal of Cardiothoracic and Vascular Anesthesia.2019; 33: 1244-1250
) verified the effects of psychological preparation on perioperative stress, anxiety, and mood in children undergoing cardiac surgery, implying that providing video games and toys preoperatively can reduce postoperative stress and anxiety and improve mood in children. In addition, researchers have evaluated specialized games (
) to relieve preoperative anxiety in children. Although these interventions have achieved certain effects, their delivery requires specialists with particular training. In addition, they are time-consuming, labor-intensive, and have limited audiences, in particular, during the peak operation period.
Attention distraction is an emotion regulation strategy commonly used in daily life (
) that actively separates an individual's attention from negative emotions and points to neutral or positive stimuli. Music or animation are the most common and affordable distraction strategies to reduce preoperative anxiety in children (
); however, their effects are inconsistent. Some researchers believe active and passive music interventions can effectively reduce preoperative anxiety (
) demonstrated that the effect of the combination of audio and video is better than that of music intervention. Moreover, previous studies have confirmed that when a mental image is experienced, an associated emotion connects the feeling state with the mind and body, leading to a physiological change (
Therefore, this study aimed to use two distraction strategies (music or animation) in pediatric surgery patients to compare the effects of the two strategies on preoperative anxiety level, anesthesia induction cooperation, and vital signs, and to explore effective methods to improve preoperative anxiety in children.
Methods
Design and methods
This study was a single-blind, randomized controlled trial. The researchers recruited pediatric patients from a general tertiary hospital in Changsha, Hunan Province, China. All patients were screened by the researchers for eligibility and then enrolled in the study if they were eligible and their parents provided consent. This study was conducted according to the CONSORT guidelines (
), the guidelines are seen in Supporting Information Appendix S1.
Participants
According to the data of the surgery center, the main types of surgeries performed on children are adenoidectomy, tonsillectomy, and pediatric concealed penile surgery. The literature shows that children aged 4–12 years commonly undergo tonsillectomy and adenoidectomy (
). Therefore, the inclusion criteria for the patients were as follows: (1) age between 3 and 12 years; (2) typical mental, psychological, and intellectual development (based on the medical history data); (3) general anesthesia surgery; and (4) the parents of the children agreed to participate in the study. The exclusion criteria were as follows: (1) children undergoing emergency surgery (2) children with unstable vital signs or critical illnesses and (3) children with visual or auditory impairment. Prior to the preoperative visit, members of the research team communicated with the parents of children who met the inclusion and exclusion criteria. They introduced the study's purpose, significance, benefits, and their rights to parents. Parents who volunteered to participate in the study were asked to sign an informed consent form.
The samples were analyzed using the PASS module of the NCSS software. We obtained the effect values μ1 = 33.65, μ2 = 54.20, σ = 20.55, and α = 0.05, β = 0.90 from the related literature (
). The sample size was calculated to be 57 patients per group and was increased to 60 participants per group, allowing for dropouts and withdrawals from the study.
Randomization and blinding
The participants were divided into three groups: animation, music, and control. First, according to the 1:1:1 balance of the three groups, the statistician set the block length to three and performed a random design of the single-blind block group. Then, according to the sequence of children entering the study, each group of three children was randomly divided into three participants in each block according to the random number table.
The blind copy was kept by the unit personnel, who had nothing to do with the experiment. The statistician saved the randomization plan, and the researcher only had the number of each participant. After opening the envelope according to the number, they knew whether the participant was in the control or intervention group. Investigators involved in the intervention were not included in the study data analysis.
Intervention
Before implementing the intervention, we established an intervention team and clarified the specific division of labor among team members. The team consisted of seven members, including one pediatrician (Deputy Chief Physician), one anesthesiologist (chief physician), and five nurses (two had master's degrees, and three had bachelor's degrees). Pediatricians and anesthesiologists were responsible for the entire construction process of the intervention plan. The nurses were responsible for implementing the entire intervention and for data collection.
The animation or music library was established through a preoperative visit survey, literature review, and expert discussion, and the intervention plan of this study was then determined. The animation library included Peppa Pig, Bears, Paws, Ultraman, and Cinderella. The music library included two categories: Bandari Light Music (Snow Dreams, New Morning, Moonglow, among others) and nursery Songs (Baby Bus, Bewa Nursery Songs, among others).
Control group
In the control group, one day before surgery, nurses from the operating room conducted routine preoperative visits, communicated with the children and their families, and conducted psychological counseling. The visit lasted for nearly 30 min.
On the day of surgery, the children were admitted to a special waiting room for children 0.5 h in advance, and a circuit nurse performed venipuncture. During this period, the child was also accompanied by a parent in the waiting room to wait for surgery. Colorful cartoon patterns were depicted on the walls of the waiting room, and various toys for children were placed indoors. After entering the operating room, a parent accompanied the child into the waiting room to wait for surgery, as in the intervention group. During this period, a nurse from the research group provided routine psychological comfort and preoperative guidance and answered questions about anesthesia and surgery raised by the children over 30–40 min. Before anesthesia induction, each child was brought into the operating room for anesthesia induction and surgery by an operating room nurse, anesthesiologist, and surgeon, while the child's parents left the waiting room and waited outside the operating room.
Intervention group
The same routine preoperative visit was conducted on the day before surgery, which lasted nearly 30 mins. On the day of surgery, the children were admitted to a special waiting room for children 0.5 h in advance, and a circuit nurse performed venipuncture. During this period, the child was accompanied by a parent in the waiting room to wait for surgery. Based on routine preoperative care in the music group, the preferred music was selected from the music library as the intervention content on the day of surgery according to the children's preference during the 1-day preoperative visit. If there was no preference, music was played randomly. During the intervention, the same multimedia audio system (Wanderer EDIFIER R1700BT) was used to play music for 30–40 min; the volume was controlled at 35–80 dB and adjusted in time according to the feedback of the children. The children in the animation group also chose their favorite cartoons as intervention content based on preoperative care. The same pad (Lenovo TB3-850F) was used to play pre-selected cartoons and volumes as the music group, which also lasted 30–40 min. During the intervention period, the children in the intervention group were accompanied by a nurse who was also responsible for implementing and maintaining the intervention program. The child's parents left the waiting room and waited outside the operating room before anesthesia induction.
Data collection
The data were collected between June and October 2019. Data collection was performed by three nursing undergraduates. The researchers assessed the children's anxiety status and recorded their heart rate and blood pressure at three-time points: before entering the operating room (baseline T0), entering the operating room (T1), and before anesthesia induction (T2). The degree of cooperation during anesthesia induction was measured only before the induction of anesthesia (T2).
Before data collection, researchers who conducted data collection were trained in the measurement tools. The training contents mainly included: (1) explaining the purpose, meaning, and scoring method of the measurement tools; (2) scoring the child's anxiety through pictures at three-time points, discussing the reasons for consistent or inconsistent results, and repeating the measurement until the coefficient of agreement, κ ≥ 0.8, was obtained.
Outcome measures
At baseline, data on the participants' demographic information and clinical characteristics were collected using a demographic information sheet designed by the researchers, including age, sex, American Society of Anesthesiologists' classification of surgical risk, surgical grade, blood pressure, and heart rate.
The primary outcome was anxiety, which was measured using the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF).
The secondary outcomes were the cooperation of the children during anesthesia induction and vital sign measurements. The children's cooperation during anesthesia induction was measured using the induction compliance checklist. The vital signs were the heart rate and blood pressure.
Modified yale preoperative anxiety scale-short form
). It can be used to describe the anxiety state of children aged 2–12 years during the perioperative period. Moreover, it is an observational behavioral, medical scale that can be used in children undergoing surgery to assess the preoperative anxiety level at four-time points: the preoperative waiting period, entering the operating room, arriving in the operating room, and the anesthesia induction period. The mYPAS includes five parts (mental state, language, emotional expression, arousal state, and dependence on parents). Jenkins (
) simplified the scale in 2014, deleting the dependent part on parents, and arriving at a simplified version of the mYPAS (mYPAS-SF) with four parts and 18 items. The measurement time points were also changed from four to two: the preoperative waiting period and anesthesia induction period. Chinese scholar Dai (
) translated the mYPAS-SF into Chinese and tested the translated version's reliability and validity. The results showed that Cronbach's alpha coefficient was 0.935. The Cronbach's alpha of the Chinese version in this study was 0.877.
) in 1998 to assess the degree of children's cooperation during anesthesia induction. There were 11 items in total, with scores ranging from 0 to 10 points. A score of 0 indicated that the induction was successful without any uncooperative behavior; 10 points indicated that the induction failed; that is, the child was completely passive, and the degree of cooperation was very poor. If the child had the same condition as the item on the scale, the child could obtain 1 point, and the points were added to obtain the final total score—the lower the total score, the better the cooperation. The scale has high internal consistency (0.998) and external consistency (0.987). In addition, the scale has excellent reliability (k = 0.995–0.998), and validity (r = 0.978) (
Vital signs such as heart rate and blood pressure were evaluated using the same portable electronic sphygmomanometer (OMRON HEM-7124). In addition, vital signs in the operating room were measured using the same ECG monitor (Minray BeneView T8).
Ethical considerations
The study protocol was approved by the Institutional Review Board of the hospital. Since the participants in this study were children, we obtained informed consent from their parents before conducting the study, and they had the right to withdraw from the study at any time without any implications for further care. This study was classified as a minimal risk investigation for the children participating. All participants' information was confidential to the research team and was only available to those directly involved in this study. It will be destroyed during central follow-up.
Data analysis
Data were analyzed using IBM SPSS 20.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to describe the background characteristics, including frequencies, percentages, ranges, means, and standard deviations. Repeated measures analysis of variance was used to evaluate the effect of the intervention on preoperative anxiety, degree of cooperation in anesthesia induction, heart rate, and blood pressure in children. A Mauchly spherical symmetry test was performed. If spherical symmetry was not satisfied, the degrees of freedom were corrected using the Greenhouse–Geisser for the F-boundary. Multiple comparisons were used to compare differences between groups at different times and at each time point in the same group. Statistical significance was considered at P-values of <0.05 (two-tailed).
Findings
Participant characteristics
A total of 181 children were recruited. Of the 181 children, the music, animation, and control groups had 61 (33.8%), 60 (33.1%), and 60 (33.1%) children, respectively. Fig. 1 presents a flowchart of the study. The mean age of all children was 7.29 (2.195, range: 3–12) years. Males accounted for 70.5% of the music group and 71.7% of the control group. Most children were between grades 1–3. Most children in the three groups had no history of surgery (control group, 90%; music group, 78.7%; and animation group, 86.7%). There was no significant difference between the three randomization groups at the baseline assessment (Table 1). No serious intervention-related adverse events were observed during this study.
Fig. 1Flow diagram of participants through the trial.
The analysis of the mYPAS-SF scores of the children in each group at different time points showed significant differences (P < 0.05) in the three groups at T1 and T2. Pairwise comparisons showed that when entering the operating room (T1), only the mYPAS-SF score of the animation group was lower than that of the control group, and the difference between the animation group and the music group was insignificant (P > 0.05); before the induction of anesthesia (T2), the scores of the music group and the animation group were both lower than those of the control group; however, there was no significant difference (P > 0.05) between them (Table 3). The analysis of mYPAS-SF scores in each group at the three-time points showed that the scores of the three groups of children increased significantly (P < 0.05). The three groups had the highest mYPAS-SF score at T2, and there were differences (P < 0.05) among the three groups in pairwise comparisons; however, the mYPAS-SF scores of the music and the animation groups were both lower than those of the control group (Table 4).
Table 3Repeated measures analysis of variance between groups at each time point ( ± s).
Variable /Time
Control group (n = 60)
Music group (n = 61)
Animation group (n = 60)
F
P
Pairwise comparison [A,B,C]
mYPAS-SF
T0
34.9 ± 10.3
33.2 ± 8.3
34.5 ± 8.5
0.56
0.571
0.313,0.818,0.437
T1
48.9 ± 12.4
45.6 ± 11.0
43.3 ± 12.0
3.34
0.038⁎
0.132,0.011⁎,0.288
T2
54.8 ± 12.3
49.2 ± 12.8
49.8 ± 10.1
4.09
0.018⁎
0.010⁎,0.022⁎,0.776
heart rate
T0
91.1 ± 12.5
92.3 ± 14.4
90.6 ± 11.6
0.26
0.775
0.626,0.838,0.488
T1
89.5 ± 14.7
91.8 ± 12.1
88.7 ± 12.6
0.88
0.417
0.355,0.724,0.201
T2
92.5 ± 16.6
93.2 ± 12.9
92.0 ± 14.2
0.10
0.908
0.803,0.852,0.663
Systolic blood pressure
T0
106.0 ± 12.4
104.9 ± 10.2
107.8 ± 11.4
1.00
0.371
0.618,0.374,0.165
T1
111.7 ± 10.8
105.1 ± 9.7
108.4 ± 12.4
5.44
0.005⁎
0.001⁎⁎,0.108,0.096
T2
108.9 ± 9.5
104.9 ± 9.2
106.5 ± 13.1
2.14
0.120
0.041⁎,0.222,0.409
diastolic blood pressure
T0
66.0 ± 10.8
64.6 ± 12.2
66.9 ± 9.0
0.68
0.509
0.493,0.641,0.249
T1
67.2 ± 8.5
67.5 ± 9.0
67.9 ± 11.6
0.06
0.939
0.856,0.724,0.863
T2
65.7 ± 10.4
65.9 ± 8.7
66.3 ± 14.9
0.05
0.952
0.924,0.759,0.832
ICC
1.9 ± 1.5
1.3 ± 1.6
1.3 ± 1.1
3.64
0.028⁎
0.023⁎,0.018⁎,0.912
Note: A: Control group vs. Music group，B: Control group vs. Animation group，C: Music group vs. Animation group； ⁎P<0.05, ⁎ ⁎P<0.01.
Although the ICC scores showed significant differences (P < 0.05) among the groups, the animation group had the lowest score. Further pairwise comparisons showed that the ICC scores of the music and animation groups were significantly (P < 0.05) lower than those of the control group; however, there was no significant (P > 0.05) difference between the groups.
Effects of two distraction interventions on vital signs of children
The results showed that there was no significant difference among the groups on vital signs (P > 0.05), except for the time effect on heart rate. Furthermore, there was no significant difference (P > 0.05) in the other vital signs, except for the systolic blood pressure of the control group, which was significantly (P < 0.05) higher than that of the music group at T1 and T2. Moreover, systolic blood pressure in the control group was significantly (P < 0.05) different at T0 vs. T1 and at T1 vs. T2. However, there was no obvious fluctuation in systolic blood pressure between the two groups (Table 4).
Outcomes stratified by age
The children were divided into preschool- and school-age based on their clinical stages. The results showed that the mYPAS-SF scores of the preschool- and school-aged children were statistically (P < 0.05) different in terms of time effect, and there was an interaction effect of intervention and time on the mYPAS-SF scores of school-aged children (Table 5, Table 6). This indicates that the two distraction interventions can reduce the anxiety levels of preschool- and school-age children at T1 and T2. However, there was no statistical difference between both groups regarding vital signs such as heart rate and systolic blood pressure (P > 0.05).
Table 5Repeated measures analysis of variance for each variable in preschool age ( ± s).
Variable /Time
Group
The effect of intervention
The effect of time
The effect of interaction
Control group (n = 11)
Music group (n = 19)
Animation group (n = 12)
F
P
F
P
F
P
mYPAS-SF
2.57
0.090
53.39
0.000 ⁎ ⁎
0.61
0.602
T0
40.5 ± 10.4
32.2 ± 9.0
35.2 ± 10.4
T1
58.9 ± 15.3
49.1 ± 9.5
48.4 ± 13.6
T2
61.1 ± 14.4
55.7 ± 16.1
52.3 ± 13.1
heart rate
0.16
0.855
3.24
0.057
0.32
0.818
T0
92.6 ± 15.7
95.4 ± 14.4
93.8 ± 10.1
T1
94.6 ± 15.4
95.8 ± 10.5
95.2 ± 15.3
T2
101.3 ± 20.2
101.2 ± 13.4
96.4 ± 15.1
Systolic blood pressure
0.16
0.851
1.80
0.182
1.00
0.400
T0
98.9 ± 8.3
102.0 ± 10.2
101.8 ± 11.9
T1
106.3 ± 6.7
102.2 ± 8.7
105.2 ± 17.1
T2
105.7 ± 9.5
101.5 ± 8.3
101.3 ± 13.6
diastolic blood pressure
0.17
0.845
1.36
0.263
0.65
0.600
T0
60.4 ± 8.5
59.4 ± 12.2
63.6 ± 9.6
T1
63.0 ± 7.7
64.0 ± 9.7
63.8 ± 14.8
T2
67.7 ± 10.7
62.8 ± 8.6
63.3 ± 20.1
Note: ⁎P<0.05, ⁎ ⁎P<0.01.
The effect of intervention refers to that because the intervention, the variable differs between the three groups.
The effect of time refers to that the variable differs between the three groups from T0 to T2.
The effect of interaction refers to the interactions between intervention and time, it presented the variable differ in intervention effect over time.
The results of the study showed that only animation intervention significantly reduced preoperative anxiety levels in children when entering the operating room. Before the induction of anesthesia, both music and animation distraction interventions reduced the level of preoperative anxiety; however, there was no significant difference between them.
Due to their young age, preschool- and school-age children cannot understand the purpose and meaning of surgery, which, coupled with unfamiliar environments, fear of pain, and separation from their families, results in varying degrees of anxiety, tension, stress, and even shock response (
). This study combined attention and distraction strategies to intervene according to the characteristics of the children during this period. A cross-sectional electronic survey aimed to evaluate media access/children's use of television, computers, mobile phones, and iPad/tablet, and observed that 57.9% of children who used new media were aged 5 years and below. The use of mobile phones, pads, computers, and TV was more common in younger children (
). Therefore, the pad-based animation distraction intervention in this study was more consistent with the daily relaxation method of most children. In this study, the method of interest induction was also incorporated into the design of the intervention strategy, and the music and animation in which the children were interested were selected as the distraction strategy, which was effective and achieved good results.
Music intervention, one of the more economical and accessible non-drug interventions, has been widely used in clinical practice and is more suitable for efficient operation in the operating room. This study showed that music intervention could effectively reduce the anxiety level of children before anesthesia induction, which is consistent with the results of a meta-analysis (
), which showed that music intervention could reduce parents' anxiety but had a limited effect on children's anxiety before anesthesia induction. In this study, the two groups had the companionship of their parents during the anesthesia induction period; hence, the effect of music intervention was different. Furthermore, both distraction strategies mobilized children's positive emotions, turned individual attention to neutral or positive stimuli, and distracted attention from surgery and anesthesia to reduce psychological fear and anxiety; therefore, the difference was insignificant. However, considering the single auditory stimulus of music, the effect of animation combined with the dual sensory dimensions of image and sound was more obvious. A systematic review (
) also showed that videos, multilevel interventions, and interactive games were more effective than music therapy and web-based interventions.
The anxiety level of the children in each group changed significantly at the three-time points (T0, T1, and T2), among which the level of anxiety before induction of anesthesia increased most significantly. The reason may be that during the induction period of anesthesia, children had to face the operating room full of instruments and operating staff, and their tension increased. Studies have also shown that the induction of anesthesia is the most threatening and painful stage throughout the perioperative period (
). However, the music and animation groups showed smaller changes in preoperative anxiety levels than the control group. After further matching the children by age stage, we observed that the two distraction interventions could reduce the anxiety level of preschool- and school-aged children when entering the operating room and before anesthesia induction.
During anesthesia induction, the ICC score also showed that the cooperation between the music and animation groups was significantly higher than that of the control group, suggesting that the use of music or animation distraction strategy can reduce surgery stimulation and anesthesia induction to put the child in a relaxed state and reduce anxiety and the stress response to anesthesia and surgery. In addition, they can also improve the degree of cooperation to anesthesia induction in children.
This study showed that the systolic blood pressure of the music group was significantly lower than that of the control group at T1 and T2, and the systolic blood pressure of the children in the control group increased significantly at the two-time points while the animation and music groups showed no significant fluctuations. Bradt (
) conducted a systematic review of adult surgical patients and observed that music intervention could reduce preoperative anxiety levels and patients' heart rate and blood pressure fluctuations. Other authors (
) showed that music intervention could reduce postoperative pulse rate, systolic blood pressure, diastolic blood pressure, and respiratory rate in adolescent patients. The results of these previous studies are consistent with those of this study. Organ development in preschool- and school-age children is not yet complete, and their mental and cognitive developments are on-going. Moreover, children show psychological rejection when faced with unfamiliar things and environments in the operating room, and it is easy to produce emotions such as fear, anxiety, and tension, which, in turn, cause physical changes (
). Through beautiful melodies or vivid images, music and animation can relieve tension in children, stabilize and maintain their blood pressure and heart rate, and reduce their fluctuations in the perioperative period.
Implications for nursing practice
Music or animation distraction strategies helped reduce preoperative anxiety and improve surgical cooperation during anesthesia induction. These distraction strategies could also provide a reference for nursing managers in mainland China and other countries with similar needs who want to perform patient-centered, accessible assistance to improve children's anxiety and surgical cooperation during surgery.
Limitations
In this study, a randomized controlled trial was conducted to compare the effects of two distraction strategies (music or animation) on alleviating preoperative anxiety in children, which provides a reference strategy for similar studies. This study also has some limitations. First, although we tried to recruit children randomly and to minimize bias by using a single-blinded design, further studies, such as multi-site randomized clinical or cluster trials, are recommended. In addition, music intervention has certain requirements for environmental settings and sound equipment; if children can truly enter the musical mood during the intervention, the effect of the intervention will increase; further research should consider how to make children truly enter the musical mood and improve the effectiveness of the intervention. Finally, there were differences in the surgical categories of children included in this study, which may have biased the results. Future research should include children in the same surgical category and age group.
Conclusions
This randomized controlled study confirmed that music and animation, which are relatively economical and accessible distraction strategies, can significantly reduce preoperative anxiety in children and improve surgical cooperation during anesthesia induction. In addition, both intervention methods are easy to operate in clinical practice, and the feedback showed that animation intervention was welcomed by most children.
Author contributions
Conceptualization, Methodology: Jingjing Wan, Xiao Wang, Jie Zhang.
Investigation: Xiao Wang, He Xin, Wenhong Tan, Yinghong Liu.
Writing-original draft: Xiao Wang, Jie Zhang, Jingjing Wan
Writing-review&editing: Jie Zhang, Xiao Wang, Jingjing Wan.
Ethics approval
This study was approved by Institutional Review Board (IRB) of the Third Xiangya Hospital, Central South University (CSU) (Changsha, Hunan province, China) before data collection. NO:2019-S506
Acknowledgments
Thanks to all the participants and researchers involved in this study.
Perioperative anxiety and stress in children undergoing congenital cardiac surgery and their parents: Effect of brief intervention-a randomized control trial.
Journal of Cardiothoracic and Vascular Anesthesia.2019; 33: 1244-1250
00266-4&id=gr1.jpg){kind=link}