Letting children watch a favorite cartoon is an effective and safe way to reduce anxiety before anesthesia and surgery, concludes a study in the November issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

"Cartoon distraction" is an "inexpensive, easy to administer, and comprehensive" technique for reducing anxiety in young children before induction of anesthesia, according to the new research, led by Dr Joengwoo Lee of Chonbuk National University Hospital, South Korea.

Cartoons Reduce Preoperative Anxiety

The study evaluated the use of cartoons to reduce anxiety in 130 children, aged three to seven, undergoing routine surgical procedures -- most commonly tonsillectomy. In a holding area, one group of patients were allowed to choose an animated movie to watch before induction of anesthesia. The children watched the movie on a tablet or laptop computer; a "Power Rangers" cartoon was the most popular choice.

Another group of children were asked to bring a favorite toy, which they were allowed to play with before induction. A third group received no special treatment. Measures of anxiety -- as rated by the parents and judged by the child's behavior -- were compared among groups.

In the holding area, anxiety scores were lower for the children who played with a favorite toy. However, after the children were moved to the operating room, anxiety was lowest for the children who watched cartoons.

According to both parent ratings and behavioral measures, only a few children in the cartoon group had increased anxiety once they went into the operating room. In contrast, nearly all of the children in the other groups had higher anxiety scores in the operating room. Anxiety was rated low or absent for 43 percent of children who watched cartoons, compared to 23 percent of those who brought a toy and seven percent with neither treatment.

Many techniques have been tried to reduce preoperative anxiety in children, with inconsistent results. Treatment with a sedative (midazolam) is probably the most common approach, but this drug has the potential for side effects.

Dr. Lee and colleagues thought watching cartoons might provide a simple way of alleviating anxiety before anesthesia by distracting the children. They write, "Preschool children generally enjoy watching animated cartoons , and they can become sufficiently engrossed to their surroundings and disregard verbal and tactile stimuli." Playing with a familiar toy may be comforting as well.

The results suggest that letting children watch cartoons "is a very effective method to alleviate preoperative anxiety," according to Dr Lee and colleagues. By providing children with a distraction during preparations for anesthesia and surgery, cartoons are an "inexpensive, easy to administer, and comprehensive method for anxiety reduction."

It may seem like a small matter to reduce anxiety by showing children cartoons. But anxiety before surgery can be a significant problem, causing emotional trauma for both the parents and children. In some cases, preoperative anxiety can lead to lasting behavioral problems, such as separation anxiety, aggressiveness, and nightmares.

The study confirms what many parents already know, according to an editorial by Drs Franklyn P. Cladis and Peter J. Davis of University of Pittsburgh: "Trying to interact with our children when "Cars" or "SpongeBob" is on television is futile." Distracting children by letting them "tune into their favorite alternative realities" seems to lower anxiety responses to surgery. Drs Cladis and Davis note that more research would be needed to determine whether reduced anxiety at induction leads to fewer behavioral problems after surgery.