A new Cochrane Systematic Review concludes that promising non-drug interventions are likely to help reduce children's anxiety during the onset of their anesthetic.
The interventions are parental acupuncture, clown doctors, hypnotherapy, low sensory stimulation and hand-held video games.
The review was conducted because undergoing a general anesthetic can be a frightening experience for a young child and distressing to parents. Children can be given a "premed" to sedate them when anesthesia is being administered, but these drugs can have unwanted harmful effects. Some non-drug alternatives have been tested to see if they could be used instead of sedative drugs when anesthesia is being administered to children. A new study is the first systematic review to investigate whether non-drug interventions are helpful in alleviating stress in children undergoing general anesthetics.
The researchers reviewed data from 17 trials that together involved 1,796 children between the ages of 10 months and 17 years. The eight studies focusing on parental presence did not find parental presence to be helpful in alleviating anxiety or improving cooperation in their children whilst the anesthetic was being administered. "It is interesting that parental presence is often encouraged, even though there it has not been shown to help," says lead researcher Allan Cyna of the Women's and Children's Hospital in Adelaide, Australia. "Based on our findings, we would recommend that parents do not need to stay for their child's anesthetic unless they are keen to do so".
The Cochrane Researchers concluded that a number of different interventions show promise in being effective in increasing cooperation and reducing anxiety in children during anesthetic administration and need further research. In single studies, clown doctors, a quiet environment, video games and computer packages (but not music therapy) each showed benefits. These promising interventions need to be tested in additional trials.
The authors also suggest that relaxation techniques targeted at parents merit further investigation, since in one trial children seemed to benefit when their parents were given acupuncture to reduce anxiety. Parental stress can be transmitted to the child. It is likely that parents who are relaxed are more likely to help their children stay calm during the administration of anesthesia. Yoga, hypnosis and meditation may help parents relax and could be explored in future studies.
"We also need more trials investigating the effects of the promising non drug interventions for children identified in this review. These, and other, methods need to be tested in further trials." says Dr Cyna.