Abstract
Background
Non-pharmacological interventions have gained increasing recognition as preoperative educational tools aim at reducing preoperative anxiety (PA) in pediatric patients and minimizing the potential adverse effects of pharmacologic interventions. This study aims to compare the effectiveness of using video animation combined with verbal communication versus verbal communication alone during the preanesthesia visit on PA in pediatric patients.
Methods
A prospective, randomized, single-blinded, controlled trial was conducted in seventy patients aged 6–12 years scheduled for elective surgery under general anesthesia. During the preanesthesia visit, participants were randomly assigned to either Group VC (n=35), receiving video animation combined with verbal communication, or Group C (n=35), receiving verbal communication alone. On the day of surgery, participant’s PA levels were assessed using the Thai-version of the modified Yale Preoperative Anxiety Scale (m-YPAS) in the holding area and upon arrival in the operating room. Parental satisfaction was also evaluated.
Results
In the holding area, the median m-YPAS score in Group VC was similar to that in Group C [28.3 (23.3, 33.3) vs. 28.3 (26.7, 36.7), P=0.26]. Upon arrival in the operating room, the median m-YPAS score in Group VC [28.3 (23.3, 36.7)] was lower than that in Group C [31.7 (28.3, 41.7)]; however, this difference was not statistically significant (P=0.52). Parental satisfaction was high in both groups.
Conclusions
Although statistical significance was not achieved, video animation combined with verbal communication showed a trend toward reducing PA and enhancing parental satisfaction, supporting its potential value as a non-pharmacological education tool for pediatric perioperative care.
Trial Registration
This study was registered at the Thai Clinical Trial Registry (TCTR20221111005).
Keywords: Anxiety, multimedia, pediatric anesthesia, preanesthesia education
Highlight box.
Key findings
• When video animation was combined with verbal communication during the preanesthesia visit in pediatric patients, the median modified Yale Preoperative Anxiety Scale score upon arrival in the operating room showed no statistically significant difference compared with verbal communication alone [28.3 (23.3, 36.7) vs. 31.7 (28.3, 41.7)].
What is known and what is new?
• Preoperative anxiety (PA) is common among pediatric surgical patients and is associated with postoperative behavioral and emotional problems. Both pharmacologic and non-pharmacologic interventions have been used to reduce anxiety.
• The findings support the role of multimodal non-pharmacologic strategies in maintaining low PA in pediatric patients. The benefit of video animation appears to be context-dependent and may be attenuated in setting with established multimodal non-pharmacologic anxiety-reducing practices.
What is the implication, and what should change now?
• Video animation is a safe, engaging, and easily implementable educational tool that may help familiarize pediatric patients and their parents with the perioperative process.
• Institutions may consider integrating short, culturally adapted video animations into routine preanesthesia visits as part of a comprehensive, multimodal approach to reduce PA.
Introduction
The incidence of preoperative anxiety (PA) in pediatric patients has been reported to range from 41.7% to 75.4% (1-4). They might present as distraught, crying, and uncooperating when approaching the operation room, which results in resistance to inhalation induction of anesthesia in approximately 25% of cases (5). Furthermore, pediatric patients with PA are at increased risk of postoperative delirium and postoperative behavioral changes such as nightmares, separation anxiety, eating problems, and increased fear of healthcare personnel. These experiences negatively affect not only the pediatric patients but also affect their parents and the anesthesia personnel involved in their case (3,6).
Strategies for reducing PA in pediatric patients can be categorized as non-pharmacologic, pharmacologic, or a combination of both. Pharmacologic interventions such as midazolam, fentanyl, ketamine, or dexmedetomidine are commonly used to reduce PA and facilitate smooth induction of anesthesia (7). However, there is growing recognition of non-pharmacologic interventions which aim to minimize the potential adverse effects associated with pharmacologic interventions. Non-pharmacological interventions are primarily designed to educate both pediatric patients and their families about perioperative process during the preoperative period, using methods such as verbal communication, leaflets, children’s books, pamphlets, videos, video games, or facility tour (7,8).
Previous studies have reported that using video animation for perioperative education could reduce parental anxiety, while its effect on reducing PA in pediatric patients remained inconclusive (9-11). We hypothesized that preanesthesia visit using video animation combined with verbal communication would reduce PA in pediatric patients. We present this article in accordance with the CONSORT reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-772/rc).
Methods
This study was a single-blind, randomized controlled study, conducted at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University during September 2022 and June 2023. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of the Khon Kaen University (No. HE651290) and informed consent was obtained from the parents or legal guardians of all patients. This study was registered at the Thai Clinical Trial Registry (TCTR20221111005).
We enrolled pediatric patients scheduled for elective surgery under general anesthesia, aged 6–12 years, classified as American Society of Anesthesiologists physical status (ASA PS) 1–2, and had no history of prior anesthesia. Excluded patients included those with intellectual, visual or hearing impairments; and those unable to comprehend and communicate effectively in the Thai language. Parent, who were allowed to be present with the patient in the holding area and the operating room and completed the parental satisfaction score, defined as either mother, father, or legal guardian.
Pediatric patients and their parents were preoperatively visited and evaluated in the admission ward on the evening of the day before surgery by the anesthesiologist responsible for the patients. After both patients and their parents or legal guardians decided to participate in the study and informed consent was obtained, the patients were randomly allocated into one of the two study groups to receive either using video animation combined with verbal communication (Group VC) or using verbal communication alone (Group C) for preoperative information by block of four randomization using a computer-generated random number (http://www.randomizer.org/). In a sealed opaque envelope, the sequential random number code was enclosed to ensure concealment of allocation. A research team member opened the envelope to reveal each patient’s group assignment before the preoperative visit and then informed the anesthesiologist responsible for the patient. Therefore, the anesthesiologist responsible for the patient was not blinded to the intervention.
In Group VC, each patient and parent received routine perioperative information through verbal communication, followed by a 3-minute 40-second video animation developed by the pediatric anesthesia team. The video provided education on perioperative care, including fasting, intravenous line insertion, the journey to the operating room and its environment, introduction of the anesthesia team, anesthesia equipment, induction of anesthesia via intravenous or facemask techniques, admission to post-anesthesia care unit, and pain management, all presented in the Thai language. Examples of the Khon Kaen University pediatric perioperative educational video animation were presented in Figure 1. In Group C, each patient and parent received only routine perioperative information through verbal communication. All pediatric patients and their parents received routine perioperative information through verbal communication provided by the anesthesiologist responsible for the patient, following a standardized preanesthesia information leaflet used at our center. They were allowed to ask additional questions during the preanesthesia visit until they clearly understood the information.
Figure 1.
Examples of scenes from the Khon Kaen perioperative educational video animation, 3-minute 40-second in length, provided education on perioperative care in the Thai language. (A) On the day before surgery, the child character represented as a girl, was shown traveling to the hospital with her parent. (B) Upon admission to the ward, she met the doctor and ward nurse. (C) The anesthesiologist visited to provide education about preoperative fasting and IV line insertion. (D) The patient was then transferred to the operating room with her parent, who stayed with her until anesthesia induction. (E) Upon arrival in the operating room, the patient was introduced to the anesthesia team and equipment, and standard monitoring (blood pressure, heart rate, and pulse oximetry) was applied. For anesthesia induction, if no IV line was present, inhalational induction via facemask was performed; otherwise, intravenous induction was administered. (F) After surgery, the patient was transferred to the post-anesthesia care unit for recovery and pain management, where the parent could rejoin her. Discharge from the post-anesthesia care unit to the ward or home occurred once discharge criteria were met. IV, intravenous.
The PA in pediatric patient was assessed by the Thai-version of the modified Yale Preoperative Anxiety Scale (m-YPAS) which was translated and validated for Thai patients and had consistently reliable correlation with the gold standard m-YPAS (12). This observational scale consists of five domains: activity, vocalization, emotional expressivity, state of apparent arousal, and use of parents. Each domain is scored from 1 to 4 except for vocalization domain, which is scored from 1 to 6. The total m-YPAS score is calculated by dividing the recorded score with the maximum score of 22 and then multiplying by 100. Therefore, the total m-YPAS score ranges from 23 to 100 based on observational assessment, with higher scores indicating greater anxiety. The total m-YPAS score greater than or equal to 30 represents significant anxiety in pediatric patients (13,14).
On the day of surgery, no preoperative sedative drugs were administered to pediatric patients prior to PA assessment. All pediatric patients and their parents were transferred to the holding area approximately 30 minutes before the scheduled time of surgery. Ten minutes after admission to the holding area, the patients were observed and the m-YPAS was scored and recorded as m-YPAS in the holding area by nurse anesthetist, who was blinded to the intervention and was not involved in the anesthesia care process. Upon arrival in the operating room, the patients were assessed again by the same nurse anesthetist and the m-YPAS was scored and recorded as m-YAS in the operating room. Two nurse anesthetists, who performed PA assessment, were trained the use of the Thai-version of the m-YPAS, and the intraclass correlation coefficient (ICC) was calculated as 0.934 [95% confidence interval (CI): 0.748–0.995]. All patients received anesthesia induction using either intravenous or inhalation induction as clinically indicated and anesthesia care by the anesthesia personnel in the operating room and post-anesthesia care unit.
After the patients underwent anesthesia, their parents returned to the holding area and completed the satisfaction score questionnaire regarding preanesthesia visit. Parental satisfaction score of preanesthesia visit was scored on a scale from 0 to 10, where 0 indicated no satisfaction at all, and 10 indicated most satisfaction. The study flow and time points of data collection was showed in Figure 2.
Figure 2.
Overview of the study flow and the time points of data collection. Group C, verbal communication alone; Group VC, video animation combined with verbal communication; m-YPAS, modified Yale Preoperative Anxiety Scale.
Data collection
Baseline characteristics of the pediatric patients including age, sex, body weight, height, ASA PS, and type of surgery, as well as characteristics of the parents including age and education level were recorded. The m-YPAS score in the operating room between the two group was compared as the primary outcome The secondary outcome were the m-YPAS score in the holding area, and parental satisfaction score of preanesthesia visit between the two groups.
Sample size calculation
We determined our sample sizes based on the hypothesis that video animation with verbal communication would decrease the m-YAS when compared to verbal communication alone for preoperative information. The estimated mean [standard deviation (SD)] m-YPAS score of 43.42 (20.28) and the clinically significant between-group mean difference of 16.58 were both derived from the previous study by Ryu et al. (15). Using a two-sided alpha level of 0.05 and a power of 90%, the calculated minimum sample size was 32 participants per group.
Statistical analysis
Continuous data were presented as mean and SD or median and interquartile range (IQR) as appropriate. Categorical data were presented as numbers and percentages. The m-YPAS and parental satisfaction score between the two groups were compare using Mann-Whitney U test. A P value of less than 0.05 was considered statistically significant. Statistical analysis was performed using STATA software for windows (Version 10.0; STATA Inc., College Station, TX, USA).
Results
Seventy patients were enrolled in the study, with 35 patients in each group (Figure 3). The median age was 9.1±1.7 years in Group VC and 8.6±2.1 years in Group C. Most patients were female in Group VC, while most patients were male in Group C. All patients’ baseline and parental characteristics were summarized in Table 1.
Figure 3.
CONSORT flow diagram of the study. Group C, verbal communication alone; Group VC, video animation combined with verbal communication.
Table 1. Baseline characteristics of pediatric patients and their parents.
| Characteristics | Group VC (n=35) | Group C (n=35) | P value |
|---|---|---|---|
| Age (years) | 9.1±1.7 | 8.6±2.2 | 0.28 |
| Female | 19 (54.3) | 11 (31.4) | 0.053 |
| Body weight (kg) | 30.0 [23, 38] | 27.0 [20, 38] | 0.36 |
| Height (cm) | 132.0±15.8 | 128.3±15.9 | 0.34 |
| ASA PS | 0.79 | ||
| I | 25 (71.4) | 24 (68.6) | |
| II | 10 (28.6) | 11 (31.4) | |
| Type of procedure | 0.74 | ||
| Orthopedic surgery | 11 (31.4) | 16 (45.7) | |
| Ophthalmic surgery | 10 (28.6) | 8 (22.9) | |
| General surgery | 4 (11.4) | 5 (14.3) | |
| Otolaryngology surgery | 5 (14.3) | 2 (5.7) | |
| Plastic surgery | 3 (8.6) | 3 (8.6) | |
| MRI procedures | 2 (5.7) | 1 (2.9) | |
| Parental age (years) | 39.5±7.4 | 41.6±9.0 | 0.29 |
| Parental education | 0.99 | ||
| Primary school | 7 (20.0) | 7 (20.0) | |
| Middle school | 5 (14.3) | 5 (14.3) | |
| Senior high school | 9 (25.7) | 10 (28.6) | |
| University | 14 (40.0) | 13 (37.1) |
Data are presented as mean ± SD, median [IQR], or n (%). Group C, verbal communication alone; Group VC, video animation combined with verbal communication. ASA PS, American Society of Anesthesiologists physical status; IQR, interquartile range; MRI, magnetic resonance imaging; SD, standard deviation.
Table 2 showed that in the holding area, the median m-YPAS score was 28.3 (23.3, 33.3) in Group VC and 28.3 (26.7, 36.7) in Group C, with no statistically significant difference between the two groups (P=0.26). Upon arrival in the operating room, the median m-YPAS score in Group VC [28.3 (23.3, 36.7)] was lower than in Group C [31.7 (28.3, 41.7)]; but there was also no statistically significant difference between the two groups (P=0.52).
Table 2. The score of the m-YPAS between the two groups.
| Area | Group VC (n=35) | Group C (n=35) | P value |
|---|---|---|---|
| In the holding area | 28.3 (23.3, 33.3) | 28.3 (26.7, 36.7) | 0.26 |
| Upon arrival in the operating room | 28.3 (23.3, 36.7) | 31.7 (28.3, 41.7) | 0.52 |
Data are presented as median (IQR). Group C, verbal communication alone; Group VC, video animation combined with verbal communication. IQR, interquartile range; m-YPAS, modified Yale Preoperative Anxiety Scale.
The median parental satisfaction score was 10 [10, 10] in Group VC and 10 [9,10] in Group C, with no statistically significant difference between the two groups (P=0.26).
Discussion
To reduce PA in pediatric patients and minimize the potential adverse effects associated with pharmacologic strategy, non-pharmacologic strategies has been increasingly used. Our randomized controlled study showed that upon arrival to the operating room, the median score of the m-YPAS in pediatric patients who received video animation combined with verbal communication was nonsignificantly lower than in those who received verbal communication alone [28.3 (23.3, 36.7) vs. 31.7 (28.3, 41.7); P=0.52]. Our result was in contrast to the study by Jaju et al., who reported that an animated education video significantly reduced the m-YPAS score compared with the control group [47.9 (10.23) vs. 77.08 (8.38); P<0.001] (16). However, the m-YPAS score in pediatric patients who received the intervention in our study showed relatively low.
Based on the study of the m-YPAS by Kain et al., pediatric patients with m-YPAS score greater than or equal to 30 were considered to have significant PA (14). In our study, both in the holding area and upon arrival in the operating room, the median m-YPAS score of pediatric patients who received video animation combined with verbal communication during preanesthesia visit were below this cutoff, suggesting reduced PA. Our findings are consistent with previous studies indicating that combining multiple non-pharmacologic interventions may be effective in reducing PA in pediatric patients (17,18).
Our study found that the median score of the m-YPAS between the two groups, both in the holding area and upon arrival in the operating room showed no statistically significance difference. This finding might be explained by the fact that the parental presence during induction of anesthesia (PPIA), which is routinely practice in our institute, was performed in both groups and may had contributed to the reduction of PA. Several meta-analysis studies demonstrated that PPIA was associated with reduction in PA in pediatric patients (17,19). Moreover, our study was conducted in school-age children, who have been reported to experience lower level of PA compared with preschool-age children (1,2).
In our study, parental satisfaction scores of preanesthesia visit were relatively high in both groups, with no statistically significant difference. Our findings are consistent with those of Spencer et al., who reported that multimedia presentation could improve parental understanding of anesthesia process and parental satisfaction (20). The major factors influencing parental satisfaction score included the quality of clinician-patient communication, clinician attitudes, shared decision-making, and the provision of sufficient anesthesia information regarding premedication, induction of anesthesia, possible risks involved with anesthesia, and pain management (21,22).
Our study had a few limitations. First, we did not evaluate the effects of anxiety on emergence agitation, postoperative delirium, postoperative pain, or postoperative maladaptive behaviors. Second, baseline anxiety levels of both pediatric patient and parents were not assessed. Lastly, we were unable to control the environmental factors during the transfer of patients from the ward to the holding area and the operating room, which might also have affected anxiety levels. Future studies may further benefit from incorporating validated child and parent self-report anxiety instruments, such as the State-Trait Operation Anxiety (STOA).
Conclusions
Although this study showed no statistically significance difference in preanesthesia visits using video animation combined with verbal communication versus verbal communication alone for reducing PA in pediatric patients, the trend toward lower PA scores suggests that short, culturally adapted video animation combined with verbal communication may be a useful tool for perioperative education during the preanesthesia visit in pediatric patients and may enhance parental satisfaction. Further studies are required to identify effective perioperative educational interventions for reducing PA in pediatric population.
Supplementary
The article’s supplementary files as
Acknowledgments
The authors gratefully acknowledge the children and their parents for agreeing to participate in this study. The authors would also like to thank the anesthesia personnel at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University for their kind assistance and Asst. Prof. Sarinya Chanthawong for her invaluable help with the paperwork.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of the Khon Kaen University (No. HE651290) and informed consent was obtained from the parents or legal guardians of all patients.
Footnotes
Reporting Checklist: The authors have completed the CONSORT reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-772/rc
Trial Protocol: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-772/tp
Funding: This work was supported by the Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (No. IN66042).
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-772/coif). The authors have no conflicts of interest to declare.
Data Sharing Statement
Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-aw-772/dss
References
- 1.Getahun AB, Endalew NS, Mersha AT, et al. Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study. Pediatric Health Med Ther 2020;11:485-94. 10.2147/PHMT.S288077 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Liang Y, Huang W, Hu X, et al. Preoperative anxiety in children aged 2-7 years old: a cross-sectional analysis of the associated risk factors. Transl Pediatr 2021;10:2024-34. 10.21037/tp-21-215 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Liu W, Xu R, Jia J, et al. Research Progress on Risk Factors of Preoperative Anxiety in Children: A Scoping Review. Int J Environ Res Public Health 2022;19:9828. 10.3390/ijerph19169828 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Huda AU, Arif A, Asim Z. Incidence of preoperative anxiety and associated features in children undergoing general anesthesia for a surgery in Middle East population. Anaesth pain intensive care 2023;27:575–8. [Google Scholar]
- 5.Kain ZN, Wang SM, Mayes LC, et al. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg 1999;88:1042-7. 10.1097/00000539-199905000-00013 [DOI] [PubMed] [Google Scholar]
- 6.Fortier MA, Kain ZN. Treating perioperative anxiety and pain in children: a tailored and innovative approach. Paediatr Anaesth 2015;25:27-35. 10.1111/pan.12546 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Otto CO, Tawuye HY, Aytolign HA, et al. Preoperative anxiety in children: prevention and management. A comprehensive review and analysis. International Journal of Surgery Open 2025;63:127-35. [Google Scholar]
- 8.Agbayani CG, Fortier MA, Kain ZN. Non-pharmacological methods of reducing perioperative anxiety in children. BJA Educ 2020;20:424-30. 10.1016/j.bjae.2020.08.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.McEwen A, Moorthy C, Quantock C, et al. The effect of videotaped preoperative information on parental anxiety during anesthesia induction for elective pediatric procedures. Paediatr Anaesth 2007;17:534-9. 10.1111/j.1460-9592.2006.02173.x [DOI] [PubMed] [Google Scholar]
- 10.Berghmans J, Weber F, van Akoleyen C, et al. Audiovisual aid viewing immediately before pediatric induction moderates the accompanying parents' anxiety. Paediatr Anaesth 2012;22:386-92. 10.1111/j.1460-9592.2011.03767.x [DOI] [PubMed] [Google Scholar]
- 11.Rudravaram S, Gupta A, Kalra B, et al. Evaluation of parental anxiety following three methods of pre-anesthesia counseling: Video, brochure and verbal communication. Paediatr Anaesth 2024;34:665-70. 10.1111/pan.14905 [DOI] [PubMed] [Google Scholar]
- 12.Aroonpruksakul N, Nithiuthai J, Jenjarat S, et al. Validation and Reliability of Full and Short Thai-Version Modified Yale Preoperative Anxiety Scale (m-YPAS) in Young Children. J Med Assoc Thai 2017;100:S53-S58. [Google Scholar]
- 13.Kain ZN, Mayes LC, Cicchetti DV, et al. Measurement tool for preoperative anxiety in young children: The yale preoperative anxiety scale. Child Neuropsychology 1995;1:203–10. [Google Scholar]
- 14.Kain ZN, Mayes LC, Cicchetti DV, et al. The Yale Preoperative Anxiety Scale: how does it compare with a "gold standard"?. Anesth Analg 1997;85:783-8. 10.1097/00000539-199710000-00012 [DOI] [PubMed] [Google Scholar]
- 15.Ryu JH, Park SJ, Park JW, et al. Randomized clinical trial of immersive virtual reality tour of the operating theatre in children before anaesthesia. Br J Surg 2017;104:1628-33. 10.1002/bjs.10684 [DOI] [PubMed] [Google Scholar]
- 16.Jaju R, Bihani P, Paliwal N, et al. Impact of a novel bundled information, education, & communication video on preoperative anxiety in paediatric patients: A randomised controlled trial. Indian J Med Res 2025;161:593-9. 10.25259/IJMR_1800_2024 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Li Y, Peng S, Xia X, et al. Nonpharmacological interventions for decreasing anxiety during anesthesia induction in children: a systematic review and Bayesian network meta-analysis. BMC Anesthesiol 2025;25:226. 10.1186/s12871-025-03077-z [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Liu T, Wang D, Wang Y, et al. Does the combination of cartoon stickers and fruit juices reduce premedication anxiety in preschool children?-a randomized controlled trial. Transl Pediatr 2025;14:1414-21. 10.21037/tp-2025-73 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Shih MC, Elvis PR, Nguyen SA, et al. Parental Presence at Induction of Anesthesia to Reduce Anxiety: A Systematic Research and Meta-Analysis. J Perianesth Nurs 2023;38:12-20. 10.1016/j.jopan.2022.03.008 [DOI] [PubMed] [Google Scholar]
- 20.Spencer SP, Stoner MJ, Kelleher K, et al. Using a Multimedia Presentation to Enhance Informed Consent in a Pediatric Emergency Department. Pediatr Emerg Care 2015;31:572-6. 10.1097/PEC.0000000000000513 [DOI] [PubMed] [Google Scholar]
- 21.Feinstein MM, Pannunzio AE, Lobell S, et al. Informed Consent in Pediatric Anesthesia: A Narrative Review. Anesth Analg 2018;127:1398-405. 10.1213/ANE.0000000000003705 [DOI] [PubMed] [Google Scholar]
- 22.Mendoza BA, Fortier MA, Trinh LN, et al. Factors impacting parental and child satisfaction in the perioperative setting. Paediatr Anaesth 2021;31:932-43. 10.1111/pan.14236 [DOI] [PubMed] [Google Scholar]