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Distraction technology suitable for the perioperative setting is readily available, but there is little evidence to show how it compares with oral midazolam in managing anxiety. Video glasses, which enable children to view and listen to cartoons and movies, may be used through the completion of inhaled induction. We compared the efficacy of oral midazolam and behavioral distraction with video glasses in managing preoperative anxiety in children.In this prospective, randomized study, 96 children aged 4 to 9 years undergoing outpatient surgery were recruited to one of 3 intervention groups receiving midazolam, video glasses, or both. The Modified Yale Preoperative Anxiety Scale was the primary dependent measure used to assess anxiety at baseline before intervention, 20 minutes later at transport to the operating room (OR), and during mask induction.There was no significant increase in anxiety score within any group between baseline and OR transport (P = 0.21, 0.42, and 0.57 for midazolam, video glasses, and combined groups, respectively). An increase in anxiety, though not large enough to be clinically significant, was observed from baseline to induction in the midazolam and combined groups (P = 0.02 and 0.03) but not in the video glasses group (P = 0.38). Confidence intervals for pairwise comparisons in Modified Yale Preoperative Anxiety Scale changes among groups were all within a clinically significant difference of 15 units.The use of video glasses and midazolam alone or in combination maintains baseline levels of anxiety at time of transport to the OR and prevents significantly increased anxiety during induction of anesthesia in children. Video glasses are not inferior to midazolam for preoperative anxiolysis and provide a safe, noninvasive, nonpharmacologic, and pleasant alternative.