Background and aims Effective pre-operative preparation program to address child’s anxiety and thus improve the quality of anaesthetic induction would need to identify the factors that affect pre-op anxiety. The factors that influence pre-operative anxiety in school-going children is likely to be different in Asian countries due to differences in socio-economic milieu. Therefore, we undertook a study to assess the factors affecting pre-operative anxiety and induction compliance in school-going children in India.

Methods After approval of Institutional Ethics Committee and written informed consent, an observational study was conducted in 60 ASA I/II children aged 7–12 years scheduled for elective surgery in a tertiary care teaching hospital. Data was collected on various possible predictors of anxiety. Child’s pre-operative anxiety was assessed as reported by the child using State-Trait Anxiety Inventory for Children (STAIC) and as observed by an independent observer using modified Yale Preoperative Anxiety scale (mYPAS). The quality of induction was assessed by Induction Compliance Checklist.

Results All the 60 enrolled children completed the study. 48% of the children had mYPAS scores >30 indicating high baseline anxiety. The parameters found to significantly influence anxiety by logistic regression were: child’s anxiety (STAIC) (p < 0.001) and parental anxiety (p = 0.006) and socio-economic status (p < 0.001). Notably, ambulatory procedures, previous surgical experience and visit to pre-anaesthesia clinic had no influence on the anxiety expressed by children. Baseline anxiety was significantly correlated with anxiety at parental separation.

Conclusion Anxiety is a significant problem in the pre-operative period in school-going children of developing countries and is inadequately addressed in the current practice.