Combined intervention of multiple methods to alleviate preoperative anxiety in preschool children undergoing strabismus surgery: a randomized controlled study

Abstract

Abstract Background Preoperative anxiety caused by strabismus surgery has an unpleasant and disturbing feeling for both children and their parents. Preoperative anxiety in children is associated with an adverse postoperative outcome. This study aimed to evaluate the effect, feasibility, and influence on postoperative behavior of three intervention programs in reducing preoperative anxiety in preschool children undergoing strabismus surgery. Methods 300 children scheduled for elective monocular strabismus correction were divided into 3 groups (n = 100 for each) by random number table method. Children in Group M received 0.1 mg/kg midazolam intravenously in the waiting room. Children in Group C watched cartoons selected by themselves in the waiting room and operating room until five minutes before the induction of anesthesia. Children in Group CM received 0.05 mg/kg midazolam intravenously in the waiting room and watched the selected cartoons continuously in the waiting room and operating room. Children’s preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) at different time points. Cooperative scores during the anesthesia induction period, recovery time, emergence agitation during the recovery period and the postoperative adverse behaviors were recorded. Result The mYPAS scores of group CM in the waiting room and before anesthesia induction were lower than those of group C and group M (P < 0.05). The incidence of agitation and adverse behavior in the group CM were lower than group C and group M (P < 0.05). The induction compliance checklist (ICC) scores of group CM and group M were lower than those of group C (P < 0.05). Group M’s recovery time was prolonged (P < 0.05). The anxiety levels in the waiting room and before anesthesia induction were positively correlated with the agitation during the recovery period, and the behavioral changes at 1 week and 1 month after the surgery. Conclusion Combining low-dose midazolam with cartoon watching in the waiting area and operating room can safely and effectively minimize preoperative anxiety in preschoolers having strabismus surgery. It was also successful in lowering emergence agitation and postoperative unfavorable behaviors. Trial registration: The study was approved by the Institutional Review Board of The Eye Hospital of Wenzhou Medical University (NO. 2021-118-K-100-01) and was registered in the Chinese Clinical Trial Registry on 01/10/2021 (http://www.chictr.org.cn, ChiCTR2100051702).