A new study by University of Adelaide researchers, in collaboration with the Women's and Children's Hospital  (WCH), has found several promising non-drug alternatives to giving "premeds" to children facing general anaesthetics.
Strategies found likely to be helpful in reducing children's anxiety include relaxation techniques for parents, including acupuncture, and, for the children, clown doctors, hypnotherapy, low sensory stimulation and hand-held video games.
The study, published in the Cochrane Database of Systematic Reviews , is the first systematic review to investigate whether non-drug interventions are helpful in alleviating stress in children undergoing general anaesthetics.
The study was carried out by researchers from the University's Australian Research Centre for Health of Women and Babies  (ARCH), Dr Allan Cyna and Philippa Middleton, together with colleagues from Starship Children's Hospital , New Zealand, and Princess Margaret Hospital  in Western Australia.
Lead researcher Dr Cyna, University Clinical Senior Lecturer and an anaesthetist with the WCH's Department of Paediatric Anaesthesia, says: "Undergoing a general anaesthetic can be a frightening experience for a young child and distressing to parents. Children can be given a `premed' to sedate them when anaesthesia is being administered, but these drugs can have unwanted harmful effects. Some non-drug alternatives have been tested to see if they could be used instead."
The researchers reviewed data from 17 trials world-wide that together involved nearly 1,800 children. They concluded that a number of different interventions show promise in increasing cooperation and reducing anxiety in children undergoing anaesthesia. In single studies, clown doctors, a quiet environment, video games and computer packages (but not music therapy) each showed benefits.
Eight studies found that the presence of parents did not help in alleviating anxiety or improving cooperation in their children.
"It is interesting that parental presence is often encouraged, even though it has not been shown to help," says Dr Cyna. "Based on our findings, we would recommend that parents do not need to stay for their child's anaesthetic unless they are keen to do so."
Further, the findings suggested that relaxation techniques targeted at parents merit further investigation. One trial showed that children seemed to benefit when their parents were given acupuncture to reduce anxiety.
"Parental stress can be transmitted to the child," says Dr Cyna. "It is likely that parents who are relaxed are more likely to help their children stay calm during the administration of anaesthesia. Yoga, hypnosis and meditation may help parents relax and could be explored in future studies."
The researchers recommended further investigation of the effects of the promising non-drug interventions for children.