Population-based incidence of anxiety-related behaviours during induction of general anaesthesia in children and efficacy of anxiolytic interventions: an international multicentre retrospective observational study.

Introduction: Preoperative anxiety in children is a significant challenge for anaesthesiologists. Although various pharmacological and non-pharmacological interventions have been explored to reduce preoperative anxiety, comprehensive data on the incidence of anxiety and the efficacy of these interventions are lacking. This study aimed to determine the incidence of anxiety in children during anaesthesia induction and evaluate the effectiveness of different interventions using real-world data. Methods: We conducted an international, multicentre, retrospective study, including patients under 18 yr undergoing general anaesthesia. Difficult inductions and anxiety were assessed using the Child Induction Behavioural Assessment tool and the Mask Acceptance Scale. Results: Among 155 604 patient encounters across six centres, the incidence of difficult induction was 6.2%, the highest rate (11.5%) in children aged 1-3 yr. Significant anxiety behaviours were seen in 22.2% of children, the highest incidence (40.8%) in 1-3-yr-olds. Difficult mask acceptance occurred in 20% of cases, highest in the 1-3-yr age group (34.2%). Premedication was associated with a decreased incidence of difficult induction (adjusted odds ratio=0.78, 95% confidence interval: 0.73-0.84, Conclusions: Most children manage without interventions, showing a lower incidence of anxiety behaviours than previously reported. This underscores the need for tailored, evidence-based strategies to address preoperative anxiety, particularly among younger children at greatest risk.