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Smartphone-based behavioural intervention alleviates children's anxiety during anaesthesia induction: A randomised
Débora O Cumino1, Joaquim E Vieira, Luciana C Lima
1From the Department of Anesthesiology and Pain, Irmandade da Santa Casa de Misericordia de São Paulo (DOC); Department of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (JEV); Faculdade Pernambucana de Saúde (LCL); and Santa Casa de São Paulo School of Medical Sciences (LPS, RAPS, LASTM).
Insights
Smartphone distraction effectively reduced preoperative anxiety in children undergoing anesthesia. This nonpharmacological approach proved beneficial, offering a valuable alternative to traditional methods for managing pediatric anxiety during medical procedures.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Behavioral Medicine
Background:
- Preoperative anxiety in children can lead to adverse anesthetic and surgical outcomes, including emergence delirium and behavioral changes.
- Nonpharmacological strategies are crucial for managing psychological stress, yet their efficacy in pediatric anxiety reduction remains debated.
- This study addresses the need for evidence-based nonpharmacological interventions for children's anxiety during anesthesia induction.
Purpose of the Study:
- To evaluate the effectiveness of nonpharmacological strategies in preventing children's anxiety during anesthesia induction.
- To compare the impact of information leaflets for parents and smartphone applications for children against a control group.
- To determine if combined interventions enhance anxiety reduction in pediatric patients.
Main Methods:
- A randomized clinical trial was conducted with 84 children (aged 4-8 years) undergoing elective surgery.
- Children were allocated to four groups: control, information leaflet for parents, smartphone application for children, or both.
- Anxiety levels were measured in the holding area and operating room during anesthesia induction via facemask.
Main Results:
- Children in the control group exhibited significantly higher anxiety levels in the operating room compared to intervention groups.
- The smartphone group and the smartphone and informed group showed the lowest median anxiety levels (23.4).
- Providing information leaflets to parents also contributed to reduced anxiety levels (28.4) compared to the control group.
Conclusions:
- Behavioral distraction using smartphone applications is an effective strategy for preventing increased anxiety in children during anesthesia induction.
- Nonpharmacological interventions, particularly digital distractions, offer a viable method for managing pediatric preoperative anxiety.
- These findings support the integration of smartphone-based distractions into routine pediatric anesthesia care.
Background:
Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial.
Objective(S):
To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction.
Design:
Randomised clinical trial.
Setting:
A tertiary care teaching hospital.
Patients:
In total, 84 children (aged 4 to 8 years; American Society of Anesthesiologists I and II) undergoing minor-to-moderate elective surgical procedures and their parents/guardians.
Interventions:
Children were randomised into four groups: control group, in which the parent/guardian was verbally informed about the anaesthetic procedure; the informed group, in which the parent/guardian was also provided with an information leaflet about the anaesthetic procedure; the smartphone group, in which the parent/guardian was verbally informed and the child received a smartphone application to play with while in the holding area before entering the operating room and the smartphone and informed group, in which the parent/guardian also received an information leaflet and the child, a smartphone application to play with while in the holding area before entering the operating room.
Main Outcome Measures:
Children's anxiety at two time points: in the holding area of the surgical centre and in the operating room during induction of anaesthesia by facemask.
Results:
Median (IQR) anxiety levels were greater at time point operating room for children in the control group (55.0; range: 30.0 to 68.4) than in the other groups: informed group, 28.4 (23.4 to 45.0); smartphone group, 23.4 (23.4 to 30.0); smartphone and informed group, 23.4 (23.4 to 25.9).
Conclusion:
The behavioural distraction strategies using smartphones were effective in preventing an increase in children's anxiety during anaesthesia induction.
Trial Registration:
clinicaltrials.gov identifier: NCT02246062.
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