Preoperative anxiety affects approximately 60 percent of pediatric patients prior to surgery, frequently complicating anesthesia induction and exacerbating postoperative pain. Addressing this clinical challenge, a randomized controlled trial published in the World Journal of Pediatrics demonstrated that a nurse-led card game intervention significantly reduced anxiety levels at operating room entry among children undergoing elective otolaryngology procedures.
- What was tested: A structured, 40-minute nurse-led card game session administered the evening before surgery to familiarize children with hospital environments and procedures.
- The primary result: Children who completed the game intervention showed measurably lower anxiety at operating-room entry and cooperated more smoothly during anesthesia induction compared to control groups.
- Postoperative impact: Caregiver reports indicated fewer post-discharge behavioral complications, such as generalized anxiety, in the intervention group.
Clinical Mechanics of Structured Therapeutic Play
Preoperative anxiety in pediatric patients is not merely a transient emotional response; it is a clinically documented physiological and psychological stressor. Research demonstrates that anxious children are harder to anesthetize, may require more sedative medication, and face an elevated risk of maladaptive behavioral changes after discharge. Pharmacological sedation carries inherent risks and costs, making non-pharmacological adjuncts critical to perioperative care.
To evaluate a scalable alternative to costly virtual reality platforms, researchers at the Children’s Hospital, Zhejiang University School of Medicine designed the Medical Vanguard card game. Delivered individually or in small groups of up to three children, the intervention utilized two specific modules: “Time-limited Treasure Hunting,” where children matched medical equipment tokens alongside brief explanations, and “Surgical Adventure,” an interactive board game mapping out the ward, operating room, and perioperative procedures.
The mechanism of action relies on cognitive reframing and distraction. By translating sterile clinical environments into familiar play formats, the intervention targets the psychological gaps identified in earlier qualitative work by the same research group—specifically, children’s fears regarding why they needed the operation, what the operating room would look like, whether the surgery would hurt, and when they would see their parents again. Utilizing validated instruments such as the modified Yale Preoperative Anxiety Scale, investigators recorded significantly lower behavioral arousal among the intervention cohort at the exact juncture when anxiety typically peaks: transport to the operating room.
Trial Analyzes 162 Pediatric Otolaryngology Patients
The single-center randomized controlled trial enrolled 164 pediatric inpatients scheduled for otolaryngology surgeries. Following random allocation, 162 participants completed the full protocol, with two withdrawals occurring in the intervention arm due to non-completion of the game protocol. Data collection evaluated multiple physiological and behavioral endpoints.
| Clinical Parameter | Intervention Group (Card Game) | Control Group (Standard Care) |
|---|---|---|
| Total Participants Analyzed | Not specified | Not specified |
| Anxiety at Operating Room Entry | Significantly Lower Scores | Elevated Baseline Anxiety |
| Anesthesia Induction Cooperation | Improved Cooperation | Standard Resistance Rates |
| Post-Discharge Behavioral Problems | Reduced (Particularly Generalized Anxiety) | Higher Incidence Reported |
| Caregiver Anxiety Scores | Elevated Upon Child Separation | Elevated Upon Child Separation |
Physiological markers such as heart rate and blood pressure exhibited standard fluctuations over time but showed no statistically significant differences between the two study arms. Similarly, caregiver anxiety scores remained comparable across groups, increasing when parents separated from their children. This specific finding highlights that while child-focused play effectively mitigates pediatric distress, adult caregivers require dedicated parallel support mechanisms.
Providers Must Evaluate Clinical Context for Play Interventions
While non-pharmacological play interventions present virtually no physiological side effects or adverse drug interactions, healthcare providers must evaluate their appropriate clinical context.
Future Directions and Implementation Pathways
The integration of low-cost, non-digital interventions into busy hospital workflows addresses a major bottleneck in global pediatric healthcare. High acquisition and maintenance costs often restrict virtual reality and advanced digital distraction tools to well-funded medical centers. In contrast, a nurse-led card game utilizing physical tokens can be readily integrated into routine inpatient preparation pathways across diverse healthcare systems.
However, investigators note distinct methodological limitations within the current data. The trial was restricted to a single center, focused exclusively on otolaryngology inpatients, and lacked long-term longitudinal follow-up beyond initial post-discharge assessments.
Future public health implementation requires larger, multicenter randomized trials to establish generalizability across broader surgical specialties and distinct geographic healthcare frameworks. If subsequent multi-site data confirm these findings, structured therapeutic play frameworks could become standard, low-cost components of routine pediatric preoperative preparation protocols internationally.
References
- Chen, J.-Q., et al. (2026). Effectiveness of a card game-based intervention in alleviating preoperative anxiety in children: a randomized controlled trial. World Journal of Pediatrics. DOI: 10.1007/s12519-026-01097-4
- Kain, Z. N., et al. (1996). Anesthesiology.
- Vernon, D. T., et al. (1965).
Disclaimer: This article is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding any questions about a medical condition or surgical procedure.
