Original ContributionThe effect of play distraction on anxiety before premedication administration: a randomized trial☆
Introduction
The majority of children scheduled to undergo surgery experience substantial anxiety in the preoperative holding area before induction of anesthesia [1], [2]. Potential causes of preoperative anxiety are separation from parents, unfamiliar environments and people, and negative anticipation of surgical procedures [1]. Anxiety in the preoperative holding area may manifest itself by facial expressions of fear, trembling, panic, crying, or even combativeness. Preoperative anxiety also has been associated with difficulty in anesthetic induction [2].
Pharmacological interventions aimed at reducing perioperative anxiety are paradoxically a source of stress in children themselves. Oral administration of such drugs may cause refusal, and insistence may aggravate anxiety [3]. Anxiety, in turn, may impair cooperation and induce refusal [4]. Taste is another factor associated with drug compliance [5]. Midazolam is frequently used in premedication [6], [7], [8] and routinely used in our department. However, the oral preparation of this drug in Turkey is bitter [9]. Premedication with midazolam, therefore, may not significantly reduce preoperative anxiety but, instead, may aggravate it in some cases if refused. The use of distraction in the form of clowns, video games, and cartoons has been shown to alleviate preoperative anxiety in children [10], [11], [12]. Although some of these interventions are more frequently used, others are not due to time constraints, adverse effects, or rising health care costs. Play dough (PD) is a simple, inexpensive toy enjoyed by the majority of preschool- and elementary school–aged children.
We performed this randomized, placebo-controlled study to test the hypothesis that playing with play dough would reduce premedication anxiety in preschool children undergoing elective surgery.
Section snippets
Methods
The study took place in August and September 2013 in Ministry of Health Yildirim Beyazit Diskapi Education and Research Hospital. Children were prospectively and consecutively enrolled in the study after their parents provided written informed consent [13]. The study protocol was approved by the Institutional Ethics Committee (reference no. 4/65, 24/09/2012) and was registered in the Australian New Zealand Clinical Trial Registry prospectively (ACTRN12613000928718).
One-hundred four healthy
Results
In August and September 2013, we enrolled 109 patients to the study (54 to group PD, 55 to group C) but dismissed 4 patients because of upper airway infection and 1 family refused the operation in the preoperative holding area so the study ended with 52 patients in each group (Fig. 1).
Group PD and group C were well matched in relation to age (P = .876), sex (P = .556), and body weight (P = .926) (Table 1).
The difference in mYPAS scores between groups at T0 was not significant (P = .876), but group PD
Discussion
In the current study, we let children play with PD before premedication with midazolam and examined whether this intervention would reduce their anxiety. We assessed anxiety using the mYPAS, which has previously been shown to be a reliable tool to measure anxiety in children [14]. We demonstrated that playing with PD significantly reduced preoperative anxiety and eased midazolam administration in children. Significant increase in mYPAS scores observed in children in the group C during midazolam
Author's contribution
GBA and RP designed the study and collected the data, GBA and SY generated the first draft of manuscript, and JE generated the last draft of the manuscript. FKA, MS, and ME performed the literature search. FKA and ÖO did the statistics.
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Cited by (17)
Anxiety and Pain in Children Undergoing Surgery: A Scoping Review
2022, Journal of Perianesthesia NursingThe effectiveness of distraction as preoperative anxiety management technique in pediatric patients: A systematic review and meta-analysis of randomized controlled trials
2022, International Journal of Nursing StudiesCitation Excerpt :Among the included studies in our meta-analysis, other distraction measures, except music, were applied as well. Liking to play is the children's nature, with toys and games as a way of playing, which are characterized by low participation difficulty and demanding high level of concentration, thus better attracting the attention of patients and relieving anxiety (Bumin Aydın et al., 2017). In addition, one study mentioned that interactive touchscreen devices have been part of the lives of young children for the past decade (Stamatios et al., 2021).
Mothers Level of Education and Preoperative Informative Story Book Reading Helps Reduce Preoperative Anxiety in Children in Turkey
2021, Journal of Pediatric NursingCitation Excerpt :Informing and preparing parents and children are of great importance for patient satisfaction, compliance, and cooperation during and after hospitalization (Kain, Mayes, et al., 1997). Different methods of reducing preoperative anxiety have been investigated, including preanesthetic medications, distraction techniques like playing with play dough (Bumin Aydın et al., 2017), web-based preoperative preparations, videotaped preoperative information (Nilsson et al., 2016), existence of parents during anesthesia induction, and preoperative psychological and educational interventions (Meletti et al., 2019; Sadegh Tabrizi et al., 2015). Preoperative education includes tours of the operating room, preadmission visits, and puppet shows (Margolis et al., 1998).
Selected highlights from clinical anesthesia and pain management
2018, Journal of Clinical AnesthesiaCitation Excerpt :Children in the play dough group reported lower mYPAS scores at 3 min after entering the preoperative holding area, and during the administration of premedication compared to the control (P ≤ 0.001). The study demonstrated that distraction in the form of playing with play dough facilitated administration of oral premedication in children [115]. This finding is similar to a previous review that revealed that parental presence during induction of anesthesia (PPIA) did not diminish the child's anxiety and that future focus should be on non-pharmacologic interventions such as video games or clips [116].
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Conflict of interest/support: There is no conflict of interest or any financial support.