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. 2015 Oct 17;41(2):182–203. doi: 10.1093/jpepsy/jsv094

Table II.

The Effectiveness of the Interventions (N = 18)

Study authors, year, country Intervention vs. comparator group(s) Scale(s) Assessment time point(s) Study outcome summary
Primary outcome: children’s preoperative anxiety
Videos
Meladmed and Siegel, 1975, USA Ia: Pre-op preparation video entitled “Ethan Has an Operation” (n = 30) Ca: Video entitled “Living Things are Everywhere” (n = 30) ORSA Night before surgery Children who watched pre-op preparation video exhibited lower anxiety than children who watched the control video (F = 3.33, p < .02)
Pinto and Hollandsworth, 1989, USA

  • Ia: Peer-narrated Pre-op preparation video with parents (n = 10)

  • Ib: Peer-narrated Pre-op preparation video without parents (n = 10)

  • Ic: Adult-narrated Pre-op preparation video with parents (n = 10)

  • Id: Adult-narrated Pre-op preparation video without parents (n = 10)

  • Ca: No videotape with parents (n = 10)

  • Cb: No videotape without parents (n = 10)

 ORSA Night before surgery Children who watched pre-op preparation videotape with their parent present exhibited less preoperative anxiety than children who did not watch the videotape (F = 7.47, p < .0001)
Durst, 1990, USA

  • Ia: Pre-op preparation video (n = 29)

  • C: Standard of care (n = 30)

 N/A Before surgery No significant difference in behaviors during the observation periods (N/A)
Robinson and Kobayashi, 1991, Australia

  • Ia: Pre-op preparation video + Child coping skills (n = 9)

  • Ib: Pre-op preparation video + Child coping skills + Parent Coping skills (n = 9)

  • Ca: Pre-op preparation video (n = 10)

 ORSA No significant difference in anxiety between all groups (F = 0.44, NS)
Karabulut and Duygu, 2009, Turkey

  • Ia: Pre-op preparation Video Compact Disc (VCD) (n = 30)

  • Ib: Training with booklet (n = 30)

  • C: No intervention (n = 30)

 STAI-C

  • 48 hr before surgery

  • 24 hr before surgery

 Children who watched pre-op preparation VCD exhibited lower anxiety than children who received no intervention (N/A)
Wakimizu et al., 2009, Japan

  • Ia: Pre-op preparation video + booklet at home (n = 77)

  • C: Standard of care (Pre-op preparation video) (n = 81)

 FACES Before surgery Children who watched pre-op preparation video at home exhibited lower anxiety than children who watched video at the hospital (F = 2.81, p = .038)
Lee et al., 2012, South Korea

  • Ia: Animated cartoon (n = 42)

  • Ib: Toy (n = 44)

  • C: Standard of care (n = 44)

 mYPAS

  • Before surgery

  • Holding area

  • In the operating room (OR)

 Children who watched animated cartoon exhibited lower anxiety in the OR than children who received standard of care (p < .05)
Mifflin et al., 2012, Canada

  • Ia: Online videoclip (n = 42)

  • C: Usual distraction techniques by anesthesiologists (n = 47)

 mYPAS During induction

  • Children who watched online videoclip exhibited lower anxiety during

  • anesthetic induction than children who received usual distraction techniques

  • by anesthesiologists (U = 497, p < .001)
Kerimoglu et al., 2013, USA

  • I: Video glasses (n = 32)

  • Ia: Midazolam + Video glasses (n = 32)

  • C: Midazolam (n = 32)

 mYPAS

  • 20 min before OR

  • Transport to OR

  • During induction

  • Children who used video glasses prevented increase in anxiety during

  • anesthetic induction (p = .38) than children who received midazolam (p = .02).

  • All three interventions prevented clinically significant increases (<15 points) in anxiety

  • from baseline (p = .39)
Multifaceted extensive program
Ellerton and Merriam, 1994, Canada

  • Ia: Day surgery program

  • (pre-op slide presentation + tour + handouts) (n = 23)

  • C: No intervention (n = 52)

 FACES Before surgery

  • Fewer children who participated in the day surgery program exhibited high preoperative anxiety than children who received no intervention

  • (Cramer’s V = 0.33, p < .04)
Kain et al., 1998, USA

  • Ia: OR tour + videotape + childlife preparation (n = 24)

  • Ib: OR tour + videotape (n = 25)

  • Ca: OR tour (n = 24)

 YPAS Holding area during induction Children who participated in the pre-op preparation program exhibited lower preoperative anxiety than children who received OR tour only (p = .02)
Kain et al., 2001, USA

  • Ia: Low sensory stimulation group (n = 33)

  • C: No intervention (n = 37)

 mYPAS

  • Entrance to the OR

  • During induction

 Children in the low sensory stimulation group exhibited lower preoperative anxiety than children in the control group (F = 6.3, p = .014)
Huth et al., 2004, USA

  • Ia: “To Tame the Hurting Thing” (Broome, 1994) included imagery booklets, a videotape, and an audiotape (n = 36)

  • Ca: Children drew on scratch art paper, received standard preoperative teaching and preparation (n = 37)

 STAI-C

  • During perioperative period

  • At home after discharge

 Children in the “To Tame the Hurting Thing” group exhibited lower anxiety than children in the attention control group (Cohen’s d = 0.12).
Kain et al., 2007, USA

  • Ia: ADVANCE (n = 96)

  • Ib: PPIA (n = 94)

  • Ic: Midazolam (n = 98)

  • C: Standard of care (n = 99)

 mYPAS

  • Holding area

  • During induction

 Children in the ADVANCE group exhibited lower preoperative anxiety in the holding area (Cohen’s d = 0.33) and during anesthetic induction (Cohen’s d = 0.54) than children in other groups
Interactive game
Patel et al., 2006, USA

  • Ia: Parental presence + video game (n = 38)

  • Ib: Parental presence + Midazolam (n = 38)

  • C: Parental presence (n = 36)

 mYPAS During induction

  • Children who played video game with parental presence exhibited lower anxiety

  • during anesthetic induction than children who received parental presence (p = .04)
Lee et al., 2013, South Korea

  • Ia: Smartphone app (n = 40)

  • Ib: Midazolam + smartphone app (n = 40)

  • C: Midazolam (n = 40)

 mYPAS

  • Holding area 5 min after intervention

  • In the OR

 Children in the Smartphone app group exhibited lower preoperative anxiety than children who received midazolam (p < .01)
Internet and music
Kain et al., 2004, USA

  • Ia: Interactive music therapy (n = 51)

  • Ib: Midazolam (n = 34)

  • C: Standard of care (n = 38)

 mYPAS During induction No significant difference in preoperative anxiety between children in the music therapy group and children in the standard of care group (p = .83)
O’Conner-Von, 2008, USA

  • Ia: Pre-op preparation Internet program (n = 28)

  • C: Standard hospital preparation program (n = 14)

  • Ca: Nontreatment group (n = 24)

 STAI-C Holding area No significant difference in preoperative anxiety between adolescents in the Internet preparation group and children in the standard preparation program group (p = .63)

Note. N/A = not available; NS = no significant difference; Ia = intervention; Ib = comparator I; Ic = comparator II; Id = comparator III; C = standard of care or no intervention; Ca = Control I; Cb = Control II; PPIA = Parental Presence during Induction of Anesthesia; ORSA = Observer Rating Scale of Anxiety; FACES = FACES Rating Scale; STAI-C = State-Trait Anxiety Inventory for Children; YPAS = Yale Preoperative Anxiety Scale; mYPAS = modified Preoperative Anxiety Scale.