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Abstracts of Posters; Presented at the International Anesthesia Research Society; 73rd Clinical and Scientific Congress; Los Angeles, CA; March 12-16, 1999: Pediatric Anesthesia


Smerling, A.J. MD; Skolnick, E. MD; Bagiella, E. PhD; Rose, C. BA; Labinsky, E. MA; Tager, F. MA

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Anesthesia & Analgesia 88(2S):p 306S, February 1999. | DOI: 10.1097/00000539-199902001-00303
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Abstract S306

INTRODUCTION: Anesthesiologists have long known that surgery can be emotionally stressful for both pediatric patients and their parents. [1] Previous attempts to alleviate this anxiety have included parental presence during induction, preoperative preparation and distractions. [2,3,4] Presently, specifically trained professional clowns entertain pediatric patients in in-patient and out-patient settings in many pediatric hospitals. The purpose of this study was to determine if perioperative clown exposure would reduce distress in children undergoing surgery.

METHODS: After IRB approval, 292 children presenting for surgery were enrolled in the study. Children who were less than six-months old or could not see the clowns were excluded from the study. A day of surgery was randomly assigned to "The Big Apple Circus" clown exposed group or to the no clown exposed group. In this way, the children in the control group (no clown) could not accidentally be exposed to clowning. The parents and patients were told that they were in a study to measure distress but were unaware that we were studying the effect of clowns. The clowns did not accompany the children during induction and the anesthesiologists were not informed which patients were in the study arm. Children were asked pre-clowning to rate their distress using a "faces scale" (1-5). At the end of the first hour of recovery the children were again asked to rate their distress. Immediately after induction the anesthesiologist was asked to rate the patients' cooperation, ease of induction and distress.

RESULTS: There were no differences between the two groups regarding induction techniques, anesthesiologist or demographics. All patients reported that their distress level increased postoperatively. The patients in the no clown group reported the highest level of distress (mean faces score 2.7), the patients who were exposed to clowns only preoperatively, reported less distress (mean faces score 2.5) and those who were treated with clowns pre and post operatively had the least distress (mean faces score 2.3). The difference between the no clown group and the pre + postop clown group was significant (p<0.05). The anesthesiologists reported that the clowned group was more cooperative, less distressed and had easier inductions (p<0.05).

DISCUSSION: This study shows that perioperative clown therapy can demonstrably decrease patient's distress.


1. Anesthesiology 43,2:251,1975
2. Can J Anaesth 37:177,1990
3. J Pediatr Psychol 1,4:31,1976
4. Anesth Analg 79:395, 1994
© 1999 International Anesthesia Research Society