The Indian Journal of Pediatrics

, Volume 84, Issue 10, pp 739–744 | Cite as

Flavored Anesthetic Masks for Inhalational Induction in Children

  • Aakriti Gupta
  • Preethy Joseph Mathew
  • Neerja Bhardwaj
Original Article



To evaluate the clinical efficacy of masking the odor of inhalational agents using fruit flavors on the anxiety behavior and compliance of children for inhalational induction.


A prospective randomized double blind, placebo controlled study was conducted on 60 unpremedicated children in the age group of 4–12 y. Thirty children received anesthetic masks smeared with a flavor of child’s choice while the other 30 children were induced using masks without flavor. Anxiety was assessed using modified Yale Pre-operative Anxiety Scale (mYPAS) in the pre-op room and during inhalational induction. Mask acceptance was graded by Induction Compliance Checklist (ICC). The cost-effectiveness of flavored anesthetic masks was compared to that of commercially available pre-scented masks.


The baseline anxiety in the two groups was comparable. The number of children demonstrating high levels of anxiety at anesthetic induction was similar in flavored and non-flavored mask groups (p 0.45). The compliance to mask induction was also equally good (p 0.99). The authors found significant difference in the cost of flavored mask (INR 56.45 per mask) as compared to commercially available pre-scented masks (INR 660 per mask).


The authors observed a placebo effect that reduced the pre-op anxiety in the control group which probably made the quality of induction equivalent with flavored and non-flavored masks. Therefore, using a flavored anesthetic mask is cost-effective than using a commercially available pre-scented mask.


Anesthetic induction Inhalational anesthesia Pediatric anesthesia Anesthetic mask Scented mask Flavored anesthetic mask 



AG: Data collection, drafting the article; PJM: Conception of the idea and formulation of methodology, data analysis, interpretation and editing of the manuscript; NB: Data analysis and interpretation and critical revision of the article. Dr. G D Puri, Professor and HOD, Department of Anesthesia and Intensive Care, PGIMER, Chandigarh will act as guarantor for the paper.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding


Supplementary material

12098_2017_2368_MOESM1_ESM.docx (19 kb)
(DOCX 18.7 kb)


  1. 1.
    Przyblo HJ, Tarbell SE, Stevenson GW. Mask fear in children presenting for anaesthesia: aversion, phobia or both? Paediatr Anaesth. 2005;15:366–70.CrossRefGoogle Scholar
  2. 2.
    Benson F, Reinand T. Mental side reactions in paediatric anaesthesia. Acta Anaesthesiol Scand. 1960;4:199–205.CrossRefGoogle Scholar
  3. 3.
    Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S. Premedication in the United States: a status report. Anesth Analg. 1997;84:427–32.CrossRefPubMedGoogle Scholar
  4. 4.
    Golden L, Pagala M, Sukhavasi S, Nagpal D, Ahmad A, Mahanta A. Giving toys to children reduces their anxiety about receiving premedication for surgery. Anesth Analg. 2006;102:1070–2.CrossRefPubMedGoogle Scholar
  5. 5.
    Kain ZN, Caramico LA, Mayes LC, Genevro JL, Bornstein MH, Hofstadter MB. Preoperative preparation programs in children: a comparative examination. Anesth Analg. 1998;87:1249–55.PubMedGoogle Scholar
  6. 6.
    Patel A, Schieble T, Davidson M, et al. Distraction with a hand held video game reduces pediatric preoperative anxiety. Paediatr Anaesth. 2006;16:1019–27.CrossRefPubMedGoogle Scholar
  7. 7.
    Kain ZN, Mayes LC, Wang SM, Caramico LA, Hofstadter MB. Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective? Anesthesiology. 1998;89:1147–56.CrossRefPubMedGoogle Scholar
  8. 8.
    Vagnolli L, Caprilli S, Robiglio A, Messeri A. Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics. 2005;116:563–7.CrossRefGoogle Scholar
  9. 9.
    Calipel S, Lucas-Polomeni MM, Wodey E, Ecoffey C. Premedication in children: hypnosis versus midazolam. Paediatr Anaesth. 2005;15:275–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Wang SM, Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth Analg. 2002;94:1489–94.PubMedGoogle Scholar
  11. 11.
    Lee J, Lee J, Lim H, et al. Cartoon distraction alleviates anxiety in children during induction of anesthesia. Anesth Analg. 2012;115:1168–73.CrossRefPubMedGoogle Scholar
  12. 12.
    Hodges RJH. Induction of anaesthesia in young children. Lancet. 1960;82:1512–3.Google Scholar
  13. 13.
    Lerman J, Sampathi V, Watt S. Induction, maintenance and emergence from anaesthesia. In: Gregory GA, Andropoulas DB, editors. Gregory’s Pediatric Anaesthesia. 5th ed. West Sussex: Blackwell Publishing Ltd; 2012. p. 330–60.Google Scholar
  14. 14.
    Cohen IT, Deutsch N, Motoyama EK. Induction, maintenance and recovery. In: Davis PJ, Cladis FP, Motoyama EK, editors. Smith’s Anaesthesia for Infants and Children. 8th ed. Philadelphia: Elsevier Mosby; 2011. p. 365–94.CrossRefGoogle Scholar
  15. 15.
    Kain ZN, Mayes LC, Cicchetti DV, et al. Measurement tool for pre-operative anxiety in young children: the Yale pre-operative anxiety scale. Child Neuropsychol. 1995;1:203–10.CrossRefGoogle Scholar
  16. 16.
    Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstader MB. The Yale pre-operative anxiety scale: how does it compare with a “gold standard”. Anesth Analg. 1997;85:783–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Kain ZN, Maclaren J, Mc Clain BC, et al. Effects of age and emotionality on the effectiveness of midazolam administered pre-operatively to children. Anesthesiology. 2007;107:545–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Davis PJ, Bosenberg A, Davidson A, et al. Pharmacology of pediatric anaesthesia. In: Davis PJ, Cladis FP, Motoyama EK, editors. Smith’s Anaesthesia for Infants and Children. 8th ed. Philadelphia: Elsevier Mosby; 2011. p. 179–261.CrossRefGoogle Scholar
  19. 19.
    Cote CJ. Pediatric anaesthesia. In: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller’s Anesthesia. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 2757–96.Google Scholar
  20. 20.
    Mathew PJ, Malik RH, Yaddanapudi S, Kohli A, Panda NB. PS-072 assessment of factors affecting pre-operative anxiety and compliance in school-going children. Arch Dis Child. 2014;99:A137–8.Google Scholar
  21. 21.
    Lewis RP, Jones MJ, Eastley RJ, Wandless JG. Fruit flavoured masks for anaesthesia induction in children. Anaesthesia. 1988;43:1052–4.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  • Aakriti Gupta
    • 1
  • Preethy Joseph Mathew
    • 1
  • Neerja Bhardwaj
    • 1
  1. 1.Department of Anesthesia and Intensive CarePostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

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