Application of a non-pharmacological technique in addition to the pharmacological protocol for the management of children’s preoperative anxiety: A 10 years’ experience

  • Francesca Scarano | Comitato Assistenza Bambini of the Lega Italiana per la Lotta contro i Tumori (CAB LILT), Treviso, Italy.
  • Alessandra Dalla Corte Comitato Assistenza Bambini of the Lega Italiana per la Lotta contro i Tumori (CAB LILT), Treviso, Italy.
  • Roberto Michielon Comitato Assistenza Bambini of the Lega Italiana per la Lotta contro i Tumori (CAB LILT), Treviso, Italy.
  • Alessandro Gava Radiotherapy Department, Ca’ Foncello Hospital and LILT, Treviso, Italy.
  • Paola Midrio Pediatric Surgery Department, Ca’ Foncello Hospital, Treviso, Italy.


The aim of the study was to investigate how Non- Pharmacological Techniques (NPT), in addition to standard pharmacological techniques, can help to manage and reduce the preoperative anxiety of children waiting for Day Surgery procedures (DS). Isola Serena activity started in 2008 to manage the preoperative time of children waiting for surgery in the playing room. The latter is run by a pedagogist. NPT includes use of games and toys, readings and drawings. A descriptive and comparative study was conducted on 50 children, aged 4 to 12 years, randomly assigned to Isola Serena group ISG and control group CG. All children received standard pharmacological techniques, while those of the ISG also received the NPT. The evaluation of the preoperative anxiety level (modified Yale Preoperative Anxiety Scale) and parent’s coping style (Coping Inventory for Stressful Situation) compared the two groups. The ISG showed a significantly lower level of preoperative anxiety than the CG. Parents’ coping style was not related to the preoperative anxiety. The activity performed in the Isola Serena Project resulted to be effective for the reduction of preoperative anxiety in children undergoing DS procedures.



PlumX Metrics


Download data is not yet available.


Kain ZN, Mayes LC, Cicchetti DV, et al. The Yale Preoperative Anxiety Scale: how does it compare with a "gold standard"? Anesth Analg 1997;85:783-8. DOI:

Johnston M. Pre-operative emotional states and post-operative recovery. Adv Psychosom Med 1986;15:1-22. DOI:

Kain ZN, Mayes LC, O'Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med 1996;150:1238-45. DOI:

Kain ZN, Caldwell-Andrews AA, Maranets I, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg 2004;99:1648-54. DOI:

Filippazzi G. Un ospedale a misura di bambino. Esperienze e proposte. 2th ed. Franco Angeli, Milano, Italy; 2004.

Cohen-Salmon D. Répercussions psychocomportementales en périopératoire chez l'enfant [Perioperative psychobehavioural changes in children]. Ann Fr Anesth Reanim 2010;29:289-300. DOI:

Kain ZN, Wang SM, Mayes LC, et al. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg 1999;88:1042-7.

Chorney JM, Kain ZN. Behavioral analysis of children's response to induction of anesthesia. Anesth Analg 2009;109:1434-40. DOI:

Mifflin KA, Hackmann T, Chorney JM. Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia. Anesth Analg 2012;115:1162-7. DOI:

Li HC, Lopez V. Effectiveness and appropriateness of therapeutic play intervention in preparing children for surgery: a randomized controlled trial study. J Spec Pediatr Nurs 2008;13:63-73. DOI:

Baldini L, Mazzarella F, Cozzi DA, Piserà A. La chirurgia pediatrica. In: Baldini L, eds. Psicologia Pediatrica. Verona, Italy: Piccin; 2009:293-311.

Lazarus RS, Folkman S. Stress, Appraisal and Coping Spinger. 1th ed. New York, NY: Springer Publishing Company; 1984.

Al-Yateem N, Brenner M, Shorrab AA, Docherty C. Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non-inferiority trial. Child Care Health Dev 2016;42:572-81. DOI:

Bumin Aydın G, Yüksel S, Ergil J. et al. The effect of play distraction on anxiety before premedication administration: a randomized trial. J Clin Anesth 2017;36:27-31. DOI:

Finley GA, Stewart SH, Buffett-Jerrott S. et al. High levels of impulsivity may contraindicate midazolam premedication in children. Can J Anaesth 2006;53:73-8. DOI:

Karimi R, Fadaiy Z, Nikbakht Nasrabadi A. et al. Effectiveness of orientation tour on children's anxiety before elective surgeries. Jpn J Nurs Sci 2014;11:10-5. DOI:

Brewer S, Gleditsch SL, Syblik D. et al. Pediatric anxiety: child life intervention in day surgery. J Pediatr Nurs 2006;21:13-22. DOI:

Lee J, Lee J, Lim H. et al. Cartoon distraction alleviates anxiety in children during induction of anesthesia. Anesth Analg 2012;115:1168-73. DOI:

Messina M, Molinaro F, Meucci D. et al. Preoperative distraction in children: hand-held videogames vs clown therapy. Pediatr Med Chir 2014;36:5-6. DOI:

Capurso, M. Gioco e studio in ospedale: creare e gestire un servizio ludico educativo in un reparto pediatrico. 1th ed. Trento, Italy: Centro Erickson; 2001.

Manyande A, Cyna AM, Yip P, et al. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev 2015. DOI:

Endler NS, Parker JD. Multidimensional assessment of coping: a critical evaluation. J Pers Soc Psychol 1990;58:844-54. DOI:

Golden L, Pagala M, Sukhavasi S. et al. Giving toys to children reduces their anxiety about receiving premedication for surgery. Anesth Analg 2006;102:1070-2. DOI:

Hosseinpour M, Memarzadeh M. Use of a preoperative playroom to prepare children for surgery. Eur J Pediatr Surg 2010;20:408-11. DOI:

Weber FS. The influence of playful activities on children's anxiety during the preoperative period at the outpatient surgical center. J Pediatr (Rio J) 2010;86:209-14. DOI:

Watson AT, Visram A. Children's preoperative anxiety and postoperative behaviour. Paediatr Anaesth 2003;13:188-204. DOI:

Kain ZN, Mayes LC, Wang SM, et al. Parental presence and a sedative premedicant for children undergoing surgery: a hierarchical study. Anesthesiology 2000;92:939-46. DOI:

Sadr Bafghi SM, Ahmadi N, Yassini Ardekani SM, et al. A Survey of Coping Strategies With Stress in Patients With Acute Myocardial Infarction and Individuals Without a History of Fixed Myocardial Infarction. Cardiol Res 2018;9:35-9. DOI:

Carotenuto M, Messina A, Monda V, et al. Maternal Stress and Coping Strategies in Developmental Dyslexia: An Italian Multicenter Study. Front Psychiatry 2017;8:295. DOI:

Preoperative anxiety, non-pharmacological techniques, day-surgery, coping strategies, children
  • Abstract views: 286

  • PDF: 55
  • HTML: 0
How to Cite
Scarano, F., Dalla Corte, A., Michielon, R., Gava, A., & Midrio, P. (2021). Application of a non-pharmacological technique in addition to the pharmacological protocol for the management of children’s preoperative anxiety: A 10 years’ experience. La Pediatria Medica E Chirurgica, 43(1).