Comparison of the Effect of Mask Preconditioning With and Without Video Demonstration on Child Induction Behaviour During Inhalational General Anaesthesia: A Randomised Controlled Trial.

BACKGROUND

Inhalational induction of anaesthesia in children is often complicated by poor facemask acceptance and perioperative anxiety, leading to crying, agitation and distress, which can create negative experiences for both children and parents. Such difficulties have been associated with prolonged induction times, increased anaesthetic risk and adverse postoperative behavioural outcomes. Several non-pharmacological strategies, including flavoured masks, audiovisual distraction and parental presence, have been explored to improve cooperation, with varying success. Mask preconditioning has been proposed as a simple, practical approach to reduce fear; however, the role of structured video demonstration combined with parental and child participation remains underexplored. This study aimed to compare facemask acceptance during inhalational induction of anaesthesia in children aged 4-10 years, with and without video demonstration of mask preconditioning.

METHODS

This single-blind, randomised controlled trial was conducted from March to May 2021 at Malankara Orthodox Syrian Church Medical College, Kerala, India. Seventy-five children were recruited; 66 were randomised (35 video and 31 no video). The intervention group viewed a prerecorded two-minute educational video demonstrating mask preconditioning, followed by parental and child simulation. The control group received only a live demonstration. Outcomes included facemask acceptance (assessed using the Child Induction Behavioural Assessment Tool (CIBAT)), time to loss of eyelash reflex (T₁) and time to intravenous (IV) cannulation (T₂). The study was approved by the Institutional Ethics Committee of Malankara Orthodox Syrian Church Medical College, Kolenchery, Kerala, India (approval number: MOSC/IEC/412/2020, date: 17-01-2020) and registered with the Clinical Trials Registry-India (CTRI/2021/03/032389).

RESULTS

Mask acceptance showed no significant difference between groups (p = 0.16). The mean time to loss of eyelash reflex was significantly longer in the video group (237.1 ± 34.4 seconds) compared to the no-video group (217.3 ± 36.9 seconds, p = 0.027). No difference was observed in the time to intravenous cannulation.

CONCLUSION

Video-assisted mask preconditioning with parental and child simulation did not significantly improve overall facemask acceptance. It was, however, associated with smoother inductions and longer times to loss of eyelash reflex. These findings are preliminary and should be interpreted cautiously in light of the study's limitations, including reduced sample size and single-centre design. Larger, multicentre studies are required to confirm these results before any consideration of routine clinical application.