The effects of distraction on preoperative anxiety in preschool and school-age children: A literature review

Children experience high levels of anxiety before surgery. Preoperative anxiety interferes with anesthesia induction compliance and is associated with many short and long-term postoperative complications The aim of this integrative review was to evaluate the impact of distraction methods on preoperative anxiety in preschool and school-age children compared to standard of care or conventional methods. A systematic search of literature was conducted using PubMed and CINHAL databases. We found 15 full-text articles in English published, between the years 2015-2019 on preschool and school-age children on PubMed, CINHAL, and keyword search according to inclusion criteria. The tools used to measure the children’s anxiety included a personal information from, separation scoring, index of clinical stress score, modified Yale preoperative assessment scale, the state-trait anxiety inventory for children, post hospitalization behavior questionnaire, Hamilton anxiety rating scale, and vital signs. Medical clowns, integrated art therapy, therapeutic play, “Play-doh”, computer games, books, and music, video games, toys, music, books, virtual reality, smartphone, relaxation-guided imagery, and iPads were used for creating distraction to reduce anxiety levels during parental separation and the preoperative period. Distraction is a safe, timely, and cost-effective non-pharmacological anxiolytic intervention that can be performed by nurses.