Do not mask the mask: use it as a premedicant TAYFUN AYDIN MD MD *, LEVENT SAHIN MD MD *, CEM ALGIN MD MD †, SAHIN KABAY MD MD ‡, MEHMET YUCEL MD MD ‡, ALPER HACIOGLU MD MD †, FAIK YAYLAK MD MD † AND ALEV KILICOGLU MD MD § Departments of *Anesthesiology and Reanimation, †General Surgery, ‡Urology and §Psychiatry, Dumlupinar University Training and Research Hospital, Kutahya, Turkey Summary 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 mgÆkg )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. Keywords: anesthesia mask; mask acceptance; gaseous induction; pediatric anesthesia Introduction Induction of anesthesia in children is a frighten- ing experience. Preoperative anxiety develops in 60% of children and may prolong the induction of Correspondence to: T. Aydin, Dumlupinar Universitesi Hastanesi, Kutahya, Turkey (email: drtayfunaydin@hotmail.com). Pediatric Anesthesia 2008 18: 107–112 doi:10.1111/j.1460-9592.2007.02381.x Ó 2007 The Authors Journal compilation Ó 2007 Blackwell Publishing Ltd 107