Do not mask the mask: Use it as a premedicant

Background: Preoperative anxiety frequently causes resistance to mask application and prolongs induction. Anesthesia masks resembling popular heroes or toys was used to deal with this problem. An anesthesia mask given on a preoperative visit to play with at home, may aid to establish a familiarity with the mask and alleviate mask fear, possibly making a gaseous induction more acceptable. Methods: After approval of the ethical committee, 50 children were randomly assigned into two groups. Both groups received conventional verbal information about the anesthetists, materials and equipment to be used for the procedure, description of gaseous induction via mask and transportation to the operating room. Additionally transparent anesthesia masks were given to children in the mask group after conventional verbal information. Both groups were premedicated with 0.3 mg·kg^-1 midazolam. Anxiety was assessed during separation from parents and induction of anesthesia by a modified Yale Preoperative Anxiety Scale. Mask acceptance quality and total mask time (TMT; time between the introduction of mask anesthesia and the loss of lid reflex) were also determined. Results: Anxiety levels in the informed group were statistically higher than in the mask group during induction of anesthesia (26 ± 1.8 vs 30 ± 2.9, P < 0.05). Mask acceptance quality was better in the mask group than in the informed group (IG). TMTs were 5.1 ± 1.3 and 7 ± 0.9 min in the mask group and in the IG, respectively. Conclusions: Playing with an anesthesia mask given during a preanesthesia visit relieved anxiety, improved mask acceptance quality and shortened the induction period. We believe that this type of premedication would be feasible in gaseous induction of anesthesia in children.