• Débora O Cumino, Joaquim E Vieira, Luciana C Lima, Livia P Stievano, Raquel A P Silva, and Ligia A S T Mathias.
• From the Department of Anesthesiology and Pain, Irmandade da Santa Casa de Misericordia de São Paulo (DOC); Department of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (JEV); Faculdade Pernambucana de Saúde (LCL); and Santa Casa de São Paulo School of Medical Sciences (LPS, RAPS, LASTM).
• Eur J Anaesthesiol. 2017 Mar 1; 34 (3): 169-175.

BackgroundPreoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial.Objective(S)To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction.DesignRandomised clinical trial.SettingA tertiary care teaching hospital.PatientsIn total, 84 children (aged 4 to 8 years; American Society of Anesthesiologists I and II) undergoing minor-to-moderate elective surgical procedures and their parents/guardians.InterventionsChildren were randomised into four groups: control group, in which the parent/guardian was verbally informed about the anaesthetic procedure; the informed group, in which the parent/guardian was also provided with an information leaflet about the anaesthetic procedure; the smartphone group, in which the parent/guardian was verbally informed and the child received a smartphone application to play with while in the holding area before entering the operating room and the smartphone and informed group, in which the parent/guardian also received an information leaflet and the child, a smartphone application to play with while in the holding area before entering the operating room.Main Outcome MeasuresChildren's anxiety at two time points: in the holding area of the surgical centre and in the operating room during induction of anaesthesia by facemask.ResultsMedian (IQR) anxiety levels were greater at time point operating room for children in the control group (55.0; range: 30.0 to 68.4) than in the other groups: informed group, 28.4 (23.4 to 45.0); smartphone group, 23.4 (23.4 to 30.0); smartphone and informed group, 23.4 (23.4 to 25.9).ConclusionThe behavioural distraction strategies using smartphones were effective in preventing an increase in children's anxiety during anaesthesia induction.Trial Registrationclinicaltrials.gov identifier: NCT02246062.

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