Surgical procedures that require general anesthesia can be stressful and create needless anxiety for school-age children. Interventions aimed at reducing preoperative anxiety can improve cooperation and enhance postoperative outcomes by lowering anxiety levels prior to induction of general anesthesia. The purpose of this study was to examine the effects of behavioral interventions versus drug therapy in reducing pre-operative anxiety in children. The secondary purpose was to compare methods used to integrate anxiety reduction interventions into pre-operative care and to evaluate the most widely used and effective strategy for clinical practice. A literature review exploring behavioral based stress reduction interventions and drug therapy targeted at reducing preoperative anxiety was conducted from various online databases. Peer reviewed articles, published in the English-language between 2006 and 2015 that focused on postoperative outcomes in which preoperative interventions to reduce anxiety in children age two years and older, as well as the parent’s perspective of the outcome, were included for synthesis. Results from 9 randomized controlled trials that used behavioral based interventions implemented on the day of surgery, prior to anesthesia induction were compared for effectiveness at anxiety reduction versus the use of drug therapy prior to surgery. The studies suggest more successful post-surgical outcomes related to shorter length of stay and post-operative delirium for behavioral interventions to reduce anxiety prior to surgery and demonstrated even greater optimal outcomes for combined behavioral interventions. Drug therapy alone to decrease anxiety prior to anesthesia induction showed mixed results in reduction of physiologic and general outcomes following surgery. No significant difference between behavioral based interventions versus drug therapy was shown in any of the reviewed studies to have a significant effect on post-surgical outcomes. However, potentially promising behavioral based interventions such as clowns, electronic devices, parental presence and music over drug therapy prior to surgery, require further evaluation for their use in decreasing pre-operative anxiety in school-age children and having a positive impact on post-operative outcomes.

Thesis Completion




Thesis Chair/Advisor

D'Amato-Kubiet, Leslee


Bachelor of Science in Nursing (B.S.N.)


College of Nursing


UCF Daytona Beach



Access Status

Open Access

Release Date

August 2016