Effects of Video-Guided Preoperative Simulation Training on Negative Postoperative Behavioral Changes in Children: A Randomized Controlled Trial

Why clinicians should know about it

• Picked for Anesthesiology and Pain Medicine (paper of the day, 23 September 2026): Phase III RCT, practice-changing for pre‑op simulation in children

Abstract

BACKGROUND: Negative postoperative behavioral changes (NPOBCs) are common postoperative complications in children and can affect children's emotional and cognitive development if not addressed. This study aimed to investigate whether simulation training could reduce the incidence of negative postoperative behavioral changes in children undergoing tonsillectomy and adenoidectomy. METHODS: In this randomized controlled clinical trial, 184 patients were randomly assigned (1:1, stratified by age) to either the control or training group. The control group received only a preoperative visit, while the training group viewed an animated instructional video and underwent simulation training using an anesthetic mask and straw following the preoperative visit. Children were evaluated using the Post-Hospitalization Behavior Questionnaire on postoperative days 3, 14, 28, 90, and 180, and negative postoperative behavioral changes were diagnosed based on a Post-Hospitalization Behavior Questionnaire score >0. The primary outcome was the cumulative incidence of negative postoperative behavioral changes during the first 28 postoperative days. Secondary outcomes included induction anxiety, induction compliance, emergence delirium, and postoperative pain. RESULTS: Compared with the control group, the training group had a significantly lower incidence of negative postoperative behavioral changes within 28 days of surgery (27.3% vs. 53.4%; odds ratio 0.33; 95% confidence interval, 0.18-0.61; P < 0.001). The training group had lower preinduction anxiety scores (31.7 [26.7, 36.7] vs. 33.3[26.7, 46.6]); P = 0.037), higher induction compliance (23.9% vs. 9.1%; P = 0.008), and a lower incidence of emergence delirium (17.0% vs. 37.5%; P = 0.002). Mediation effect analysis revealed that the intervention may reduce the incidence of negative postoperative behavioral changes by alleviating anxiety. CONCLUSIONS: Preoperative simulation training reduced the incidence of short-term negative postoperative behavioral changes and improved perioperative psychological outcomes in children who underwent tonsillectomy and adenoidectomy, suggesting a feasible nonpharmacological strategy to enhance pediatric perioperative care. CLINICAL TRIAL REGISTRY AND NUMBER: ChiCTR2400083163.

Abstract as published, via PubMed.