Surgical Serenity: How to Help Kids Cope with Anesthesia Anxiety?

Anxiety during anesthesia induction in children is a significant concern, associated with various adverse outcomes, including behavioral issues and prolonged induction times. Approximately 50-67% of pediatric patients experience this anxiety, highlighting the necessity for effective management strategies. Nonpharmacological interventions, such as parental presence, psychological therapy, and virtual reality, have been proposed as alternatives to pharmacological methods like midazolam, which can have undesirable effects. However, the specific impacts of various nonpharmacological interventions remain ambiguous due to a scarcity of direct comparative studies.

Recent systematic review analyzed 34 randomized controlled trials (RCTs) involving 3,040 participants to compare the efficacy of different nonpharmacological interventions. A Bayesian network meta-analysis approach facilitated both direct and indirect comparisons, crucial given the lack of head-to-head trials. The primary outcomes measured included anxiety levels during induction, assessed using standardized scales such as the modified Yale Preoperative Anxiety Scale (mYPAS).

Results of Nonpharmacological Interventions

Results indicated that interventions combining parental presence with interactive distraction techniques (PDI-PPIA and IDI-PPIA) showed the highest efficacy in reducing anxiety during anesthesia induction, achieving statistical significance with standardized mean differences (SMD) of -1.94 and -1.83, respectively. In contrast, traditional parental presence interventions alone (PPIA) and other passive or interactive distractions were less effective, with SMDs ranging from -0.91 to -1.18. Notably, no interventions demonstrated a significant reduction in parental anxiety levels.

Quality Assessment of Studies

The meticulous quality assessment revealed a predominantly low to moderate risk of bias across studies, although some concerns were raised regarding outcome measurement, primarily due to observer blinding issues. Sensitivity analyses confirmed the primary findings, reinforcing the conclusion that specific nonpharmacological strategies provide effective means to mitigate preoperative anxiety in children. The analysis underscores the pressing need for future head-to-head trials to further delineate the comparative effectiveness of these strategies, particularly in diverse populations and settings. Subgroup analyses were constrained by limited data on intravenous versus inhalation induction methods, suggesting a vital area for future exploration. The findings advocate for the integration of tailored, family-centered interventions into clinical practice to enhance the overall perioperative experience for pediatric patients.

Key Points

- Anxiety prevalence during anesthesia induction in pediatric patients is significant, with 50-67% experiencing anxiety, leading to behavioral issues and prolonged induction times, necessitating effective management strategies.

- A systematic review of 34 randomized controlled trials (RCTs) involving 3,040 participants was conducted to evaluate the efficacy of various nonpharmacological interventions compared to traditional pharmacological methods.

- Bayesian network meta-analysis was utilized to facilitate both direct and indirect comparisons of interventions, with the primary outcome being anxiety levels during induction measured by standardized scales like the modified Yale Preoperative Anxiety Scale (mYPAS).

- Interventions combining parental presence with interactive distraction techniques (PDI-PPIA and IDI-PPIA) demonstrated the highest efficacy in reducing anxiety with significant standardized mean differences (SMDs) of -1.94 and -1.83, whereas traditional parental presence alone (PPIA) and other distraction methods showed lower efficacy (SMDs range from -0.91 to -1.18).

- Quality assessment of the included studies revealed a low to moderate risk of bias, with concerns primarily related to outcome measurement and observer blinding, though sensitivity analyses confirmed the robustness of the primary findings.

- The findings emphasize the necessity for future head-to-head trials to better understand the comparative effectiveness of nonpharmacological interventions, particularly in diverse populations, while advocating for family-centered strategies to improve the perioperative experience for pediatric patients.

Reference –

Yuanyuan Li et al. (2025). Nonpharmacological Interventions For Decreasing Anxiety During Anesthesia Induction In Children: A Systematic Review And Bayesian Network Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03077-z.