title: Cartoon distraction alleviates anxiety in children during induction of anesthesia.
abstract: BACKGROUND
  We performed this study to determine the beneficial effects of viewing an animated cartoon and playing with a favorite toy on preoperative anxiety in children aged 3 to 7 years in the operating room before anesthesia induction.
  
  
  METHODS
  One hundred thirty children aged 3 to 7 years with ASA physical status I or II were enrolled. Subjects were randomly assigned to 1 of 3 groups: group 1 (control), group 2 (toy), and group 3 (animated cartoon). The children in group 2 were asked to bring their favorite toy and were allowed to play with it until anesthesia induction. The children in group 3 watched their selected animated cartoon until anesthesia induction. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) and parent-recorded anxiety Visual Analog Scale (VAS) the night before surgery, in the preanesthetic holding room, and just before anesthesia induction.
  
  
  RESULTS
  In the preanesthetic holding room, the group 2 mYPAS and parent-recorded anxiety VAS scores were significantly lower than those of groups 1 and 3 (mYPAS: P = 0.007; parent-recorded anxiety VAS: P = 0.02). In the operating room, the children in group 3 had the lowest mYPAS and parent-recorded anxiety VAS scores among the 3 groups (mYPAS: P < 0.001; parent-recorded anxiety VAS: P < 0.001). In group 3, the mYPAS and parent-recorded anxiety VAS scores of only 3 and 5 children were increased in the operating room compared with their scores in the preanesthetic holding room, whereas the anxiety scores of 32 and 34 children in group 1 and 25 and 32 children in group 2 had increased (P < 0.001). The number of children whose scores indicated no anxiety (mYPAS score <30) in the operating room was 3 (7%), 9 (23%), and 18 (43%) in groups 1, 2, and 3, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Allowing the viewing of animated cartoons by pediatric surgical patients is a very effective method to alleviate preoperative anxiety. Our study suggests that this intervention is an inexpensive, easy to administer, and comprehensive method for anxiety reduction in the pediatric surgical population.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chonbuk National University.
authors.forename: Jeongwoo
authors.initials: J
authors.lastname: Lee
authors.forename: Jihye
authors.initials: J
authors.lastname: Lee
authors.forename: Hyungsun
authors.initials: H
authors.lastname: Lim
authors.forename: Ji-Seon
authors.initials: JS
authors.lastname: Son
authors.forename: Jun-Rae
authors.initials: JR
authors.lastname: Lee
authors.forename: Dong-Chan
authors.initials: DC
authors.lastname: Kim
authors.forename: Seonghoon
authors.initials: S
authors.lastname: Ko
mesh_terms: D000367:Age Factors; D000758:Anesthesia / Q000379:methods / Q000523:psychology*; D001007:Anxiety / Q000517:prevention & control* / Q000523:psychology*; D002359:Cartoons as Topic / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods / Q000523:psychology*; D011446:Prospective Studies; D014742:Videodisc Recording