# The Effect of Preoperative Visual Explanation on Anxiety in Children: A Randomized Controlled Trial

## TL;DR

Using pictures to explain surgery to children reduces their anxiety and helps parents feel calmer before the procedure.

## Contribution

Demonstrates that visual explanations significantly reduce preoperative anxiety in children and prevent awakening agitation.

## Key findings

- Children who received visual explanations had lower anxiety scores at multiple time points before surgery.
- Heart rates during induction and surgery were significantly lower in the visual explanation group.
- Parents of children in the visual explanation group reported lower anxiety levels at all measured time points.

## Abstract

Background/Objectives: This study aimed to investigate the effects of explaining the perioperative process to pediatric patients scheduled for adenotonsillectomy using pictures on their anxiety levels. Methods: A prospective, randomized controlled trial was conducted, enrolling 58 patients. The patients were divided into two groups: Group 1 (n = 29), where the perioperative process was explained using pictures, and Group 2 (n = 29), the control group, where no pictures were used. Child anxiety was assessed using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) at five observation time points before anesthesia induction. Parents’ anxiety was measured using the Visual Analog Scale for Anxiety. Results: Patients in Group 1 had significantly lower heart rates during induction and the intraoperative period compared to Group 2 (p = 0.031, p = 0.025, respectively). In terms of anxiety and RSAS scores, patients in Group 1 had significantly lower mYPAS-SF scores at time points t2, t3, t4, and t5 compared to Group 2 (t2: p = 0.001; t3–t5: p < 0.001). No significant difference was observed at t1 (p = 0.068). The mean RSAS scores were also significantly lower in Group 1 (p = 0.029). Parents’ anxiety was significantly lower in Group 1 at all three time points (t1: p = 0.017; t2: p = 0.006; t3: p = 0.036). Conclusions: Our study results demonstrate that illustrating the perioperative process to children undergoing adenotonsillectomy can significantly reduce preoperative anxiety and prevent awakening agitation. Given its ease of implementation, we believe that using visual aids to explain the perioperative process to pediatric patients can facilitate process management for patients, parents, and physicians.