Clowns as Treatment for Preoperative Anxiety in Children: A Randomized Controlled Trial

This study has been completed.
Information provided by:
Sheba Medical Center Identifier:
First received: January 24, 2008
Last updated: February 6, 2008
Last verified: January 2008
This study wants to test the hypothesis that trained clowns can reduce anxiety in children undergoing general anesthesia. We will compare the effect of the clowns to the commonly used anti-anxiety medication we commonly use

Condition Intervention
Pre Operative Anxiety
Behavioral: clowns present
Drug: midazolam

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Caregiver)
Primary Purpose: Supportive Care
Official Title: Clowns as Treatment for Preoperative Anxietyin Children- a Randomized Controlled Trial

Resource links provided by NLM:

Further study details as provided by Sheba Medical Center:

Primary Outcome Measures:
  • anxiety level [ Time Frame: waiting area and enterance to OR -1 hour ] [ Designated as safety issue: No ]

Enrollment: 65
Study Start Date: January 2006
Study Completion Date: January 2007
Primary Completion Date: January 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: 1
no medication or clowns present during the preopertaive phase
Active Comparator: 2
midazolam a anxiolytic drug was given in the preoperative phase
Drug: midazolam
Active Comparator: 3
clowns where present during the preoperative phase
Behavioral: clowns present
clowns present during the proccess of induction of anesthesia

Detailed Description:

The perioperative environment, often anxiety-provoking for adults, may be quite frightening for children. The detrimental effects of preoperative anxiety are not confined to the preoperative period. Anxiety during induction of anesthesia is correlated with increased distress early in the postoperative period, (Holms Knud, Kain) and maladaptive behavior will follow for the first 2 weeks following surgery in up to 54% of children.

Many preoperative systems allow parental, pharmacologic, and anticipatory interventions to facilitate a relaxed perioperative environment for children. Unfortunately, scheduling conflicts, side effects, and limited resources conspire to limit their usefulness. For example, only 10% of respondents in a recent survey used parental presence during induction of anesthesia (PPIA) for a majority of their patients. This may be due to the belief by some that parental anxiety may in fact increase children's anxiety. (Bevans) According to the same survey, only 50% of children undergoing surgery receive sedating premedication. (Kain). Distraction techniques, such as the use of toys or video games, may also decrease perioperative anxiety, however their effectiveness during induction of anesthesia is not well characterized. The efficacy of toys and video games is somewhat dependent upon the child reaching certain developmental milestones. Anesthesiologists continue to search for an easy and comprehensive method for anxiety reduction in the pediatric surgical population. We propose that specially trained professional clowns may allay preoperative anxiety and result in a smooth anesthetic induction.


Ages Eligible for Study:   2 Years to 8 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • ASA I and II
  • Children aged 2-8 years

Exclusion Criteria:

  • Previous surgery
  • ASA > II
  • Parents' refusal
  Contacts and Locations
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Please refer to this study by its identifier: NCT00609960

Sheba Medical Center
Tel Hashomer, Ramat Gan, Israel, 52621
Sponsors and Collaborators
Sheba Medical Center
Principal Investigator: Ilan Keidan, MD Sheba medical Center - Israel
  More Information

Responsible Party: Ilan Keidan MD, Director pediatric anesthesia, Sheba Medical Center Identifier: NCT00609960     History of Changes
Other Study ID Numbers: SHEBA-05-3739-IK-CTIL 
Study First Received: January 24, 2008
Last Updated: February 6, 2008
Health Authority: Israel: Israeli Health Ministry Pharmaceutical Administration

Keywords provided by Sheba Medical Center:
children anesthesia anxiety clowns

Additional relevant MeSH terms:
Adjuvants, Anesthesia
Anesthetics, General
Anesthetics, Intravenous
Anti-Anxiety Agents
Central Nervous System Depressants
GABA Agents
GABA Modulators
Hypnotics and Sedatives
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Physiological Effects of Drugs
Psychotropic Drugs
Tranquilizing Agents processed this record on May 26, 2016