Authors Keywords: preoperative, paediatric anxiety, modified Yale Preoperative Anxiety Score, Induction Compliance Checklist, audiovisual distraction, non-pharmacological Abstract

Background: Although distraction therapy has shown benefits, studies have not been done in developing countries. This study aimed to compare audiovisual distraction to standard practice to decrease preoperative anxiety at induction in children undergoing surgery at Rahima Moosa Mother and Child Hospital (RMMCH).

Methods: A contextual pre- and post-intervention control group study was conducted with children aged 3–10 years. Each group was allocated 30 children. During the preoperative assessment, children in the intervention group watched a cartoon from a preselected list. The modified Yale Preoperative Anxiety Scale (mYPAS) was used to assess anxiety on arrival and at induction, with a score > 30 regarded as anxious. The Induction Compliance Checklist (ICC) was used to assess compliance at induction.

Results: At induction, the control group had significantly higher median (interquartile range [IQR]) mYPAS scores (60, 42.5–67.5 versus 31.7, 28.3–39.2; p < 0.001) and were significantly less compliant (p = 0.001). Fewer children in the intervention group were anxious at induction (17, 56.6% versus 29, 96.7%; odds ratio [OR] = 0.05, 95.0% confidence interval [CI] = 0.00 to 0.37; p = 0.0004). Between arrival and induction, the control group had significantly increased mYPAS scores (p < 0.001), while the intervention group had significantly decreased scores (p < 0.001). There was a significant correlation between mYPAS and ICC scores in both the control (r = 0.74, p < 0.001) and the intervention (r = 0.74, p = 0.03) groups at induction. There was no correlation between cartoon-watching time and mYPAS scores (r = -0.29, p = 0.125), no difference between the mYPAS scores of males and females (p = 0.933), or those with or without a traumatic experience (p = 0.441) at induction.

Conclusion: This study demonstrates a significant decrease in anxiety at induction in the children receiving audiovisual distraction. The intervention group was more compliant at induction. Smartphone-based audiovisual distraction offers a cost-effective, easy-to-use mobile intervention.

Author Biographies E Dale, University of the Witwatersrand

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

J Scribante, University of the Witwatersrand

Department of Paediatric Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand and Surgeons for Little Lives, South Africa

H Perrie, University of the Witwatersrand

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

Z Jooma, University of the Witwatersrand

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

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