title: Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option?
abstract: OBJECTIVE
  A significant number of children undergo surgery experience high levels of anxiety in the presurgical period. The aim of this study is to investigate which intervention is more effective in reducing preoperative anxiety.
  
  
  METHODS
  The sample was composed of 75 subjects (aged 5-12 years) who had to undergo minor day surgery. Children were randomly assigned to: the Clowns group (N = 25) accompanied to the preoperative room by the clowns and by a parent; Premedication group (N = 25) premedicated with oral midazolam and accompanied to the preoperative room by one parent; or the Control group (N = 25) only accompanied by one parent. Anxiety in the preoperative period was measured by using the Modified Yale Preoperative Anxiety Scale (m-YPAS). Parental anxiety was measured by using the State-Trait Anxiety Inventory (STAI Y-1/Y-2).
  
  
  RESULTS
  The Clown group was significantly less anxious during the induction of anesthesia compared with Premedication group and Control group. There were not any significant differences between Control group and Premedication group. There was an increased level of anxiety in the induction room in comparison with the waiting room: this difference was statistically significant for Control group and Premedication group, whereas it was not significant in Clown group.
  
  
  CONCLUSIONS
  PPIA+clown intervention is more effective in reducing anxiety in children during the preoperative period than PPIA alone or PPIA+oral midazolam.
authors.affiliation: Pain Service, A. Meyer Children's Hospital - Florence, Viale Pieraccini, Firenze, Italy. lauravagnoli@virgilio.it
authors.forename: Laura
authors.initials: L
authors.lastname: Vagnoli
authors.forename: Simona
authors.initials: S
authors.lastname: Caprilli
authors.forename: Andrea
authors.initials: A
authors.lastname: Messeri
mesh_terms: D000488:Allied Health Personnel; D000556:Ambulatory Surgical Procedures; D000758:Anesthesia / Q000523:psychology*; D001007:Anxiety / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D009483:Neuropsychological Tests; D010290:Parents; D011229:Preanesthetic Medication; D011300:Preoperative Care; D011446:Prospective Studies; D018401:Sample Size; D014925:Wit and Humor as Topic
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam