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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-. doi: 10.1002/14651858.CD006447.pub3

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Non‐pharmacological interventions for assisting the induction of anaesthesia in children

This version published: 2015; Review content assessed as up-to-date: August 28, 2014.

Link to full article: [Cochrane Library]

Plain language summary


The initial process of giving general anaesthesia (i.e. induction of anaesthesia) to children can be distressing for them and their parents. Children can be given a sedative medicine (premedication) to drink such as midazolam before anaesthesia is induced in order to help the child relax. However these drugs can have undesirable effects, such as possible airway obstruction before anaesthesia begins and during recovery. In addition behaviour changes may occur after the operation. Some non‐drug alternatives have been tested to see if they could help children relax and co‐operate at the beginning of their anaesthesia. This review aims to assess the effects of non‐drug interventions such as hypnosis, acupuncture and video games in helping with the beginning of general anaesthesia in children

Key findings

We included 28 trials (2681 children under the age of 18 years and or their parents) with a large number of interventions (17) assessed.

The presence of parents at induction of the child's anaesthesia has been the most commonly investigated intervention (eight trials), but has not been shown to reduce anxiety or distress in children, or increase their cooperation during induction of anaesthesia.

Although parents should not be actively discouraged from being present if they prefer to do so, equally parents should not be encouraged to be present at their child's induction if they prefer not to do so.

Most commonly other interventions are given to the child (e.g. video games or hypnosis) but sometimes the intervention is given to the parent. One study of acupuncture for parents found that the parent was less anxious, and the child was more co‐operative, at induction of anaesthesia. Another study of giving parents information, in the form of pamphlets or videos, failed to show an effect. In other studies looking at interventions for children, clowns or clown doctors, a quiet environment, video games and computer packages (but not music therapy) each showed benefits such as improved co‐operation in the children.

Quality of the evidence

Many of the studies were of poor quality and too small to provide clear answers to the study question. However potentially promising non‐pharmacological interventions such as parental acupuncture; clowns/clown doctors; playing videos of the child's choice during induction, pre‐operative hypnosis and hand‐held video games require further testing in future studies. Non‐drug interventions that might help parents relax need further study, as there is some evidence that more relaxed parents may improve their child's anaesthesia induction experience.


Background: Induction of general anaesthesia can be distressing for children. Non‐pharmacological methods for reducing anxiety and improving cooperation may avoid the adverse effects of preoperative sedation.

Objectives: To assess the effects of non‐pharmacological interventions in assisting induction of anaesthesia in children by reducing their anxiety, distress or increasing their cooperation.

Search methods: In this updated review we searched CENTRAL (the Cochrane Library 2012, Issue 12) and searched the following databases from inception to 15 January 2013: MEDLINE, EMBASE, PsycINFO and Web of Science. We reran the search in August 2014. We will deal with the single study found to be of interest when we next update the review.

Selection criteria: We included randomized controlled trials of a non‐pharmacological intervention implemented on the day of surgery or anaesthesia.

Data collection and analysis: At least two review authors independently extracted data and assessed risk of bias in trials.

Main results: We included 28 trials (2681 children) investigating 17 interventions of interest; all trials were conducted in high‐income countries. Overall we judged the trials to be at high risk of bias. Except for parental acupuncture (graded low), all other GRADE assessments of the primary outcomes of comparisons were very low, indicating a high degree of uncertainty about the overall findings.

Authors' conclusions: This review shows that the presence of parents during induction of general anaesthesia does not diminish their child's anxiety. Potentially promising non‐pharmacological interventions such as parental acupuncture; clowns/clown doctors; playing videos of the child's choice during induction; low sensory stimulation; and hand‐held video games need further investigation in larger studies.

Editorial Group: Cochrane Anaesthesia, Critical and Emergency Care Group.

Publication status: New search for studies and content updated (no change to conclusions).

Citation: Manyande A, Cyna AM, Yip P, Chooi C, Middleton P. Non‐pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD006447. DOI: 10.1002/14651858.CD006447.pub3. Link to Cochrane Library. [PubMed: 26171895]

Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 26171895


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