Current clinical status of perioperative comfort therapy in pediatric anesthesia in China: a national cross-sectional survey.

Objective: To investigate the current implementation of and key barriers to perioperative comfort therapy in pediatric anesthesia in China, and to provide evidence-based support for optimizing the perioperative anesthesia experience of children. Methods: A cross-sectional online survey was conducted from March 21 to May 21, 2025. Using convenience sampling, an anonymous electronic questionnaire was distributed to anesthesiologists nationwide via the WeChat group of the Pediatric Anesthesia Branch of the Chinese Society of Cardiothoracic and Vascular Anesthesia. Participants were invited to complete the survey anonymously and were requested to provide objective institutional data as completely and accurately as possible. The questionnaire comprised 22 closed-ended questions and 3 open-ended questions, covering preoperative and postoperative anesthesia management, parental presence rates, and other relevant indicators. Data analysis and visualization were performed using SPSS version 27.0 and GraphPad Prism 10. Results: A total of 150 valid responses were collected. Participating hospitals were predominantly tertiary A-grade facilities, accounting for 79.3% of the sample. Preoperative visits were universally implemented (100%) and preoperative education, fasting instructions, and explanations of anesthesia plans were provided in 95.3%, 94.0%, and 92.7% of hospitals, respectively, non-routine premedication remained the most common anxiolytic strategy, reported by 59.3% of hospitals. When premedication was used, dexmedetomidine, midazolam, and ketamine or esketamine were the main agents, reported by 29.3%, 25.3%, and 20.0% of hospitals, respectively. Non-pharmacological interventions were widely adopted, including comfort toys or picture books in 84.4%, play therapy in 44.2%, and educational videos in 36.1% of hospitals, whereas virtual reality was rarely used, with a utilization rate of 9.5%. Parental presence was permitted during anesthesia induction in 30.0% of hospitals and in the post-anesthesia care unit (PACU) in 20.7%. Only 12.7% of hospitals had dedicated induction rooms. The main barriers to parental presence were concerns regarding parental emotional distress, reported by 75.3% of respondents, and increased workload, reported by 73.3%. Notably, only 34.0% of hospitals used standardized scales to assess emergence delirium. Propofol was the most commonly used intervention for emergence delirium, accounting for 48.0%, while early parental comforting accounted for 21.3%. Conclusions: In China, current pediatric perioperative anesthesia management remains insufficient in addressing children's psychological well-being, and interventions aimed at reducing perioperative anxiety are suboptimal. These shortcomings are mainly reflected in three areas: first, inadequate assessment of children's anxiety during preoperative education and insufficient preoperative anxiolytic measures; second, a substantial discrepancy between recognition of the importance of parental presence during anesthesia induction and recovery and its limited implementation in clinical practice; and third, underuse of standardized assessment scales for emergence delirium, together with limited diversity in management strategies. These limitations are likely attributable to constraints in medical resources and insufficient staffing.