Audiovisual technology intervention for reducing preoperative anxiety in children undergoing general anesthesia: A systematic review and meta-analysis

Preoperative anxiety (POA) is a concern for children undergoing surgery, especially with general anesthesia. POA can result in many postoperative problems, such as physical, psychological, and financial problems. Nonpharmacological treatments have been investigated for reducing POA as they are more pleasant and have fewer adverse effects compared to pharmacological treatments. Audiovisual technology treatment is one of the nonpharmacological treatments developed lately. This study aims to evaluate the efficacy of an audiovisual technology intervention for reducing POA in children undergoing general anesthesia. This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guideline 2020. Google Scholar, PubMed, ProQuest, and Cochrane databases were used for searching English articles published between January 2015 and June 2023. Cochrane Review Manager 5.4 was used for the meta-analysis and the Risk of Bias Tool 2.0 was used to measure the risk of bias. The studies included were randomized controlled trials (RCTs) that compared the audiovisual technology intervention with a control population. The modified Yale Preoperative Anxiety Scale was the outcome of interest. We found 627 articles in four databases using the search term. After screening with the eligibility criteria, three studies from Iran, Denmark, and China were included in the meta-analysis. A random effect model was applied. The meta-analysis resulted in a significant result as a lower modified Yale Preoperative Anxiety Scale score was found in the audiovisual technology intervention group compared with the control group (mean difference -10.75 [-16.48 to -5.03]; 95% confidence interval; P = .0002.) The presence of audiovisual technology interventions such as video games, cartoons or animation videos, and smartphone applications could significantly lower POA in children undergoing general anesthesia.