RCT of Parent Led exposure to anaesthetic mask to prevent child pre-op anxiety

This was a randomised controlled trial looking the effect of pre-operative exposure to an anaesthetic mask on the anxiety and compliance of children age 4-7 years attending for day surgery under GA with mask induction.

A previous study has demonstrated significantly reduced anxiety if the mask exposure was done on the day of admission. The Authors of this study added an arm with mask exposure for a week (at least 3 times in the week) prior to surgery with the hypothesis that children in this arm would be less anxious and more compliant than those who were exposed only on the day, who in turn would be less anxious than those in the control (no mask exposure group). Similarly self-reported anxiety rates of parents in the week long exposure group were expected to be lower than in either of the other groups.

Multiple time course and group comparisons were made with observer-rated anxiety consistently highest at induction in all groups (with anxiety increasing from admission and holding to transfer and induction). There was significantly less anxiety on average in the children exposed to the mask on day of surgery compared to control (supports the literature) but this difference was not apparent in the week long exposure group. Interestingly, children in the day-of exposure group were equally anxious as the no-exposure group at admission, but were less anxious at induction, which, as the authors point out, is perhaps where this intervention has its effect. Parental anxiety reduced over the course of the day but was no different in any group.

The study did not allow the use of video’s or games at induction and may be less applicable in centers that do this routinely. The mask was mailed to the parents in the week long group with instructions about graded exposure and the parents were asked to journal compliance with instructions. This may be non-ideal in study populations but is the reality in paediatric anaesthesia. The exact level of blinding is not well explained, and is perhaps less than ideal, although in the instances where more than one person was available to conduct observations the results correlated well.

Take home message

Exposing children to an anaesthesia mask at admission on the day of surgery may reduce their anxiety at the time of gas induction. There does not appear to be any benefit in commencing the exposure any earlier.

Reviewed by: Dr Rochelle Barron