Clinical question

How effective are non-pharmacological interventions in assisting induction of anaesthesia in children?

Bottom line

In single studies, a quiet environment, clown doctors, video games and computer packages (but not music therapy) each showed benefits, such as improved cooperation in children. One study of acupuncture for parents found the parent was less anxious and the child was more cooperative at induction of anaesthesia. Another study of giving parents information, in the form of pamphlets or videos, failed to show an effect. The presence of parents at induction of the child's anaesthesia was not shown to reduce anxiety or distress in children, or increase their cooperation.  

Caveat

Most of the outcomes of this review were based on single studies. Although most studies used some sort of scoring system, few used the same score for measuring anxiety and cooperation. Similarly, other outcome measures were rarely consistent across studies. Even though only randomised or quasi-randomised controlled trials were included in this review, poor methodology and inadequate reporting limited data extraction and presentation of analyses.  

Context

The induction of anaesthesia in children can be distressing for the child and also for their parents. Children can be given drugs to sedate them, but these drugs can have unwanted harmful effects, such as possible airway obstruction and behaviour changes after the operation. Some non-drug alternatives have been tested to see if they could be used instead of sedatives.

Cochrane Systematic Review

Yip P et al. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Reviews 2009, Issue 3. Article No. CD006447. DOI: 10.1002/14651858. CD006447.pub2. This review contains 17 studies involving 1796 participants.