title: A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children.
abstract: OBJECTIVE
  To test whether a combined intervention of art therapy and clown visits could enhance the efficacy of oral medication in reducing children's anxiety at parental separation prior to induction of anaesthesia.
  
  
  BACKGROUND
  Approximately 50% of children undergoing surgery report high anxiety at anaesthesia induction. Complementary therapies have been used to decrease children's anxiety, but no study has evaluated the efficacy of a combination of such therapies.
  
  
  METHODS
  This is an observational study, which involved allocating different interventions to two groups and measuring their anxiety at two time points.
  
  
  METHODS
  This study assigned 78 children (aged 3-11 years) undergoing general anaesthesia for surgery to two conditions. The control group underwent general anaesthesia following standard practice, and the intervention group received an intervention of integrated art therapy and clown visits upon their arrival at the hospital and throughout their time in the preoperating room. Each child in both groups received 0·5 mg/kg oral midazolam 30 minutes before surgery and had a parent present throughout their time in the preoperating room. Each child's anxiety was evaluated twice using the Modified Yale Preoperative Anxiety Scale: at baseline and at separation from parents. Repeated measures anova was used to test for differences between the time points and the two groups.
  
  
  RESULTS
  Children in the intervention group showed a significant (p < 0·001) reduction in Modified Yale Preoperative Anxiety Scale scores at parental separation compared to those in the control group. Additionally, the majority of parents and nurses evaluated the intervention to be effective for reducing children's anxiety.
  
  
  CONCLUSIONS
  This study found that an intervention based on art therapy and clown visits enhanced the effect of midazolam in reducing children's anxiety at preoperative separation from parents.
  
  
  CONCLUSIONS
  Paediatric staffs may consider using such a combination of strategies in preparing children for anaesthesia induction.
authors.affiliation: Federazione Nazionale Clowndottori, Cesena, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dionigi
authors.affiliation: Department of Psychology, University of Bologna, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gremigni
mesh_terms: D000768:Anesthesia, General / Q000523:psychology*; D001008:Anxiety Disorders / Q000628:therapy*; D001155:Art Therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D027641:Laughter Therapy; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D010371:Pediatric Nursing / Q000379:methods*; D057234:Preoperative Period
chemical_list: D008874:Midazolam
keywords: anxiety; art therapy; clowns; paediatric surgery; parental presence; premedication