Colouring Activity Versus Video Distraction Technique To Alleviate Preoperative Paediatric Patient Anxiety: A Randomised Control Trial

Preoperative anxiety affects >75% of paediatric patients, manifesting as fear and distress,

particularly during induction of General Anaesthesia (GA)1

. This anxiety can lead to increased

postoperative pain, emergence delirium, increased analgesic requirements and negative

postoperative behavioural changes such as sleep disturbance, separation anxiety, eating

problems and new-onset enuresis 2,3 Anxiety has long-term adverse effects which may lead to

separation anxiety disorders and healthcare avoidance in the future. Research shows a clear

effect of artistic interventions on self-report4 measures of decrease in stress, anxiety, and mood.

Anaesthesiologists have employed a variety of pharmacological and non-pharmacological

strategies to alleviate anxiety in paediatric patients. Pharmacological interventions include

medications such as midazolam 5, clonidine 6 and dexmedetomidine7. On the other hand, non-

pharmacological approaches encompass therapeutic play8,9

, music therapy10

, clown

intervention11, 12

, hypnosis13

, storytelling14

, head play15

, engaging children in video games 16

,

and interactive activities with play dough17

. Additionally, strategies like pre-operative

information video18

, and web-based tailored intervention19 have been explored. More

innovative techniques, such as smartphones20 and Virtual Reality (VR) tours21 of the operating

theatre, along with video distraction22 methods, have also been studied for their effectiveness

in reducing anxiety in young patients during medical procedures.

Research shows that non-pharmacological methods are superior to pharmacological methods

to alleviate paediatric patient anxiety, and they can be used without the fear of causing any side

effects23

. Midazolam is associated with delayed onset of action associated with adverse effects

such as agitation, restlessness and extended duration of hospitalisation among patients24

. Pre-

operative education empowers children to approach surgery with positive expectations and also

improve the caregiver’s perception of the experience25

.

Colouring activity helps lower anxiety in children through several mechanisms26

. i)

mindfulness and focus: Engaging in colouring allows children to utilise all their senses,

promoting presence in the moment. ii) Structured Creativity: Working with pre-drawn

templates offers a clear structure, which can be less overwhelming than colouring on a blank

page. iii) Relaxation Response: The repetitive nature of colouring provides a calming rhythm

akin to meditation, which aids relaxation and lowers cortisol levels. iv) Emotional Expression:

Colouring enables children to visually express their emotions, facilitating communication

about their feelings and promoting emotional release. These factors make colouring a valuable

tool for managing anxiety in paediatric populations.

Hypothesis: Engaging in colouring activities provides a superior anxiolytic effect in children

due to its soothing properties, prolonged calming effects, and the sense of achievement it

fosters. Additionally, it allows children to express their emotions creatively in a non-verbal

manner, potentially enhancing their emotional well-being. We planned this study to evaluate

the effect of using colouring activities in the Child information sheet in the preoperative period

on decreasing the preoperative anxiety in children in OT

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