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PEDIATRIC ANESTHESIA

Sensory Stimuli and Anxiety in Children Undergoing Surgery: A Randomized, Controlled Trial

Zeev N. Kain, MD^*, Shu-Ming Wang, MD^*, Linda C. Mayes, MD, Dawn M. Krivutza, MA^*, and Barbara A. Teague, BSN^§

Departments of *Anesthesiology, Pediatrics, and Child Psychiatry, and the §Children’s Clinical Research Center, Yale-New Haven Children’s Hospital and Yale University School of Medicine, New Haven, Connecticut

Address correspondence and reprint requests to Zeev N. Kain, MD, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510. Address e-mail to kain{at}biomed.med.yale.edu

We assessed the effectiveness of a behavioral intervention aimed at reducing the anxiety of children undergoing anesthesia and surgery. The intervention consisted of dimmed operating room (OR) lights (200 Lx) and soft background music (Bach’s "Air on a G String," 50–60 dB). Only one person, the attending anesthesiologist, interacted with the child during the induction of anesthesia. Children undergoing anesthesia and surgery were randomly assigned either to a low sensory stimulation group (LSSG, n = 33) or to control group (n = 37). By using validated behavioral measures of anxiety (mYPAS) and compliance (ICC), children were evaluated at the preoperative holding area and during the induction of anesthesia. On postoperative Days 1, 2, 3, 7, and 14, the behavioral recovery of the children was assessed by using the Post Hospitalization Behavior Questionnaire. We found that the LSSG was significantly less anxious compared with the control group on entrance to the OR (P = 0.03) and on the introduction of the anesthesia mask (P = 0.003). Also, the compliance during the induction of anesthesia was significantly better in children assigned to the LSSG (P = 0.02). The incidence of postoperative behavioral changes, however, did not differ significantly between the two groups (P = ns). We conclude that children who are exposed to low-level sensory stimuli during the induction of anesthesia and who are exposed to background music exhibit lower levels of anxiety and increased compliance.

Implications: Children are less anxious and show increased compliance during induction when exposed to a single care-provider in a dimmed, quiet operating room with background music.

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