Does the combination of cartoon stickers and fruit juices reduce premedication anxiety in preschool children?-a randomized controlled trial.

BACKGROUND

Perioperative anxiety affects 40-75% of children undergoing surgery, risking complications. Midazolam (0.5 mg/kg) is commonly used but poorly tolerated due to bitterness. This study aimed to determine whether a combination of favorite carton stickers and fruit juices could reduce premedication anxiety in preschool children scheduled for elective surgery.

METHODS

One hundred and fifty-five healthy children, aged 3-6 years, assigned to elective surgery were randomized to one of four groups: Group A, control group (premedication with traditional midazolam monosaccharide syrup mixtures); Group B, cartoon stickers before traditional premedication; Group C, fruit juices midazolam mixtures premedication and Group D, cartoon stickers and premedication with midazolam fruit juices mixtures. All groups routinely received sedative premedication (oral midazolam, 0.5 mg/kg) before anesthesia induction. The modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) was used to evaluate the anxiety of each child in the following time points: T0 (baseline anxiety: immediately after arriving in the preoperative holding area), T1 (3 min after the interventions), T2 (at the time of midazolam oral administration).

RESULTS

There was no significant difference in mYPAS-SF scores among the four groups at T0 (P=0.17). Children in Group D manifested significantly the lowest mYPAS-SF scores at T1 compared with the other three groups (vs. Group A, P<0.001, Group B, P=0.02 and Group C, P=0.02) and T2 (vs. Group A, Group B and Group C, P<0.001). Subjects in Group B showed lower mYPAS-SF scores than those in Group A at T1 (P=0.043) and T2 (P=0.01). Patients in Group C showed lower mYPAS-SF scores than those in Group A at T1 (P<0.001) and T2 (P<0.001). There was no statistically significant difference in the mYPAS-SF scores of children in Group B and Group C at time T1 (P=0.13) and T2 (P=0.15).

CONCLUSIONS

Cartoon stickers for reducing premedication anxiety were effective, besides, the combination of cartoon stickers and fruit juices was found to be an effective tool to reduce premedication anxiety in preschool children undergoing elective surgery.

TRIAL REGISTRATION: ChiCTR2200066644 (registered at the Chinese Clinical Trial Registry, www.chictr.org.cn).