Varying screen size for passive video distraction during induction of anesthesia in low‐risk children: A pilot randomized controlled trial

Abstract

Background: Preoperative anxiety affects up to 65% of children who undergo anesthesia induction and often results in uncooperative behavior. Electronic devices have been used to distract children to reduce anxiety and create a more enjoyable preoperative experience. Few studies have compared the effects of different video delivery systems on preoperative anxiety. Aims: The primary aim was to determine if a large projection-based video screen mounted to a patient's bed decreased anxiety when compared to a tablet during mask induction of anesthesia in children from 4-10 years of age. Methods: We performed a prospective, randomized trial to determine differences in our primary outcome, preoperative anxiety, between the large Bedside Entertainment and Relaxation Theater (BERT) and a smaller tablet screen. Secondary outcomes included (a) induction compliance; (b) child fear; (c) frequency of emergence delirium; and (d) satisfaction. Results: In examining the primary outcome for 52 patients, there was a main effect for time on mYPAS scores, f(2, 51) = 13.18, P < 0.01. mYPAS scores significantly increased across time for both groups. The interaction for time (T0, T1 or T2) × group (BERT vs Tablet) was not significant, f(2, 51) = 1.96, P = 0.15; thus changes in mYPAS scores across time did not differ by group status. There was no significant difference in induction compliance, child fear, emergence delirium, or satisfaction between the two groups. Conclusion: In a low-risk population, preoperative anxiety was low and induction compliance was high when pairing screen-based distraction interventions, regardless of size, with parental presence at induction of anesthesia. K E Y W O R D S anesthesia, anxiety, child, parent-child relations, patient compliance, video distraction | 649 RODRIGUEZ Et al.

Virtual reality for pediatric periprocedural care

“…However, for some children, parent present inductions may paradoxically lead to increased anxiety [32]. Given that anesthesiologists have previously provided induction anxiolysis with distracting screen-based content, virtual reality offers a novel distracting anxiolytic with complete immersion [33–38]. A recent, well designed randomized controlled trial where virtual reality distraction was introduced immediately prior to mask induction of 5-to-12-year old children resulted in significantly lower anxiety [39 ▪▪ ].…”

A Systematic Review of Tablet-Based Interactive Distraction as a Preoperative Anxiolytic in Pediatric Patients Undergoing Same-Day Procedures

“…during a surgical course. Four of the five studies in this review demonstrated that TBID either reduced preoperative anxiety (2,4) or, at minimum, did not increase anxiety during the induction of anesthesia (1,5). Marechal et al found that the average m-YPAS scores (anxiety levels) over four measurements were decreased in the TAB group [14].…”

“…Traditionally, benzodiazepines, beta-blockers, and opioids have been used preoperatively to minimize preoperative anxiety. Although these medications reduce preoperative anxiety, several studies suggest that the emerging approach of tablet-based interactive distraction (TBID) offers a novel and promising alternative equally effective as a preoperative anxiolytic in pediatric patients [1][2][3][4][5][6][7]. TBID involves age-appropriate video games that have been preloaded onto a tablet (TAB) and given to a pediatric patient before administering anesthesia.…”

Overview and Strategy Analysis of Technology-Based Nonpharmacological Interventions for In-Hospital Delirium Prevention and Reduction: Systematic Scoping Review

“…The interventions in these studies involved diverse technologies across the categories, that is, audio [ 33 , 49 ], light [ 42 ], sleep aids [ 19 ], communication support [ 21 ], others [ 46 ], and multiple components [ 24 , 51 , 52 ]. Of the 14 studies without significant effect on direct outcome measures, 8 studies, however, showed significant effects on delirium risk factors or symptoms, including pain [ 40 ], anxiety [ 35 , 36 , 38 , 50 ], agitation [ 54 ], hallucination [ 54 ], and factual memory encoding [ 45 ]. Six of the 8 studies using diverse technology-based interventions showed a significant effect on indirect outcome measures, including anxiety [ 39 ], agitation [ 43 ], sleep deprivation [ 44 ], or ICU readmission [ 59 ].…”

“…First, most technology-based interventions addressed only one or a few delirium risk factors. For instance, interventions that used a dynamic light system [ 41 , 60 ] aimed to improve the patients’ sleep-wake cycle while interventions, including video distraction [ 34 , 35 , 43 ], aimed to reduce the anxiety of the patients. Such approaches are not in line with the frequently recommended multicomponent approach, which effectively targets the multifactorial origin of delirium [ 15 ].…”