Surgical visits carry an element of threat [1]. During the immediate preoperative period, just one day before surgery, distress is common for both children and their parents, regardless of the nature of the surgery or whether it takes place in an outpatient or inpatient care unit [2,3]. The prevalence of preoperative anxiety among surgical patients was found to be 48% [4]. In developed countries, approximately 21,59,000 surgeries are performed annually on children under 15 years of age. The reported incidence of preoperative anxiety in children ranges from 40% to 60% [5,6].

Up to 60% of children undergoing surgery with general anesthesia experience anxiety while waiting and during the induction process [[6], [7], [8]]. Anxiety levels increase from 48% in the preoperative room to 72% at the time of parental separation and 95% during anesthesia induction [9]. A study in India reported even higher rates of preoperative anxiety among children, with 76% in the preoperative room, 93% during parental separation, and 96% during anesthetic induction [10].

Preoperative anxiety in children can lead to negative behavioral changes, significant pain, sleep disturbances, feelings of nausea, fatigue, poor response to anesthesia and painkillers, and increased healthcare costs. Anxiety also elevates stress hormone levels and leads to tachycardia [[11], [12], [13]]. These symptoms may persist for up to two weeks after surgery [14].

In an effort to reduce child anxiety before surgery, sedatives and anti-anxiety drugs are commonly administered. However, these treatments often have adverse effects and may prolong patient recovery. Consequently, there is a growing focus on nonpharmacological complementary interventions to reduce preoperative anxiety, such as music and visual imagery techniques [14].

Music intervention encompasses music therapy (MT) and music medicine (MM). MT involves the systematic use of musical experiences to achieve therapeutic goals by a trained music therapist (MTt), emphasizing the relationship between the patient, music, and MTt. Passive listening to pre-recorded music provided by a nurse or medical staff is considered music medicine (MM) [14]. Music helps divert the patient's attention from stressful events to something pleasant, thus reducing anxiety [15,16]. Medical professionals have used music interventions (MT and MM) in various medical fields to address patients' physiological, psychological, and spiritual needs. Evidence suggests that music interventions can be beneficial in reducing anxiety in children facing terminal illness, chronic illness, and undergoing surgeries [14]. However, access to music therapists is limited in low- and middle-income countries. A study by Kain ZN et al. demonstrated that music medicine intervention (passive listening to soft background music) with dimmed operating room light (200 lux) significantly reduced preoperative anxiety compared to a control group of children who underwent surgery without this intervention [17].

The visual imagery technique (VIT) involves creating a detailed mental image of an attractive and peaceful setting or environment. VIT is recognized as a treatment for anxiety, depression, learning disabilities, and attention deficit disorder, as well as a preparation method for children before surgery and medical procedures [18,19].

These interventions have additional medical benefits, such as reducing pain intensity, improving mood, enhancing the quality of life, maintaining normal vital signs, and reducing the duration of hospital stays and treatment costs [14,[20], [21], [22]]. Moreover, there are no side effects associated with these therapies.

To the best of our knowledge, no study has compared the effects of MM and VIT on preoperative anxiety in children undergoing surgery. Therefore, our aim was to compare the impact of MM and VIT with conventional treatment (CT) on preoperative anxiety among children between 6 and 12 years of age undergoing surgery.