The effect of videotaped preoperative information on parental anxiety during anaesthetic induction for elective paediatric procedures
Authors: McEwen A.M. , Moorthy C. , Quantock C. , Rose H. 
Published: May 2007

Introduction:  It has long been recognised that parents of children scheduled for elective surgery experience high levels of pathological anxiety (1). Providing parents with information about anaesthesia, surgery and postoperative recovery has been identified as a tool for reducing anxiety (2–4). The purpose of this study was to determine whether audiovisual information, describing the process of undergoing and recovering from anaesthesia, could reduce anxiety levels and desire for information in parents before their child's induction of anaesthesia.

Methods:  The study was approved by our local ethics committee. 111 Parents were recruited into this study. Of these 56 were randomised to a control group and 55 to an intervention group. All parents completed the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire on admission to hospital on the day of surgery and then again just before accompanying their child to the anaesthetic room. This is a tool for assessing preoperative anxiety and need for information, which has previously been validated in the parents of children presenting for surgery (5). In addition to the normal preoperative preparation, parents randomised into the intervention group watched a short 8 min information video after completing the first questionnaire. The video illustrated the events and procedures surrounding a child's admission to hospital for day‐case surgery, including the induction of anaesthesia.

Results:  There was no statistically significant difference in child demographics, type of surgical procedure, parental demographics, parental experience or STAI‐Trait scores between the two groups (P > 0.1). A repeated measures ANOVAfor APAIS scores revealed a significant group × time interaction for all three measures, Anxiety Scale (F (1,109) = 6.2; P < 0.05), Need for Information Scale (F (1,109) = 7.7; P < 0.01) and total score (F (1,109) = 11.1; P < 0.001). Further analysis revealed that the intervention group demonstrated a reduction in anxiety (effect size 0.47), need for information (effect size 0.53) and total scores (effect size 0.63) as measured by the APAIS, compared with controls (Figure 1).

 APAIS scores: means and standard error bars for anxiety, desire for information and total, pre and postvideo.

image

Discussion:  We postulated that audiovisual information has a role in parental education and reducing parental anxiety before paediatric surgery. However few studies have been carried out examining the efficacy of audiovisual information and all published studies have been carried out in institutions in the USA. Our study is the first to examine the usefulness of videotaped information in a childrens hospital in the UK. In this study we demonstrated that a preanaesthetic educational videotape can reduce parental anxiety before paediatric day case surgery. Our study also suggests that an information video may reduce a parents desire for information. However as the APAIS score does not formally measure the effectiveness of information transfer we cannot discount the possibility that the reduced desire for information is a result of an expectation bias or may have been produced by an overly intimidating video. We have also demonstrated that the cost of making an effective information video need not be prohibitive. Our video was produced with the aid of our medical photography department and the final cost was £800 ($1.487), (€1.170).

Conclusions:  Providing parents with an information video depicting the process of undergoing and recovering from anaesthesia and surgery results in a significant reduction in their anxiety and may reduce their desire for information. Future studies should examine the effect of audiovisual information on anxiety in children before surgery.

References  1 Thompson N, Irwin MG, Gunawardene MS et al. Preoperative parental anxiety. Anaesthesia

1996; 51: 1008–1012.

2 McEwen AW, Caldicott LD, Barker I. Parents in the anaesthetic room parents and anaesthetists view. Anaesthesia 1995; 50: 368.

3 Shirley PJ, Thompson N, Kenward M et al. Parental anxiety before elective surgery in children. A British perspective. Anaesthesia 1998; 53: 956–959.

4 Lee A, Chui PT, Gin T. Educating patients about anaesthesia: a systematic review of randomized controlled trials of media based information. Anesthesia and Analgesia 2003; 96:1424–1431.

5 Miller KM, Wysocki T, Cassady JF et al. Validation of measures of parents’ preoperative anxiety and anesthesia knowledge. Anesth and Analg 1999; 88: 251–257.