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The Use of Tablet Computers to Reduce Preoperative Anxiety in Children Before Anesthesia: A Randomized Controlled
Nicola G Clausen1, Dorthe Madsen1, Charlotte Rosenkilde1
1Department of Anaesthesiology and Intensive Care, University Hospital Odense, Odense, Denmark; Department of Clinical Research - Anaesthesiology, University of Southern Denmark, Odense, Denmark.
Insights
Tablet games may reduce preoperative anxiety (POA) in young children before surgery. While not statistically significant, this intervention showed potential for lowering anxiety at anesthetic induction, though pain and emergence delirium were unaffected.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Digital Health Interventions
Background:
- Preoperative anxiety (POA) is common in children undergoing surgery and anesthesia, leading to adverse outcomes.
- Pharmacological anxiolytics have side effects, and non-pharmacological methods can be resource-intensive.
- Exploring novel, accessible interventions like tablet games is crucial for managing pediatric perioperative anxiety.
Purpose of the Study:
- To evaluate the efficacy of an age-appropriate tablet game in reducing preoperative anxiety (POA) in children aged 3-6 years.
- To assess the impact of tablet gaming on postoperative pain and emergence delirium (ED).
- To determine if tablet use is a viable non-pharmacological intervention in a clinical setting.
Main Methods:
- A randomized controlled trial involving 60 children (3-6 years) undergoing elective minor surgery.
- Intervention group played a tablet game pre-anesthesia; control group received standard care.
- Preoperative anxiety, emergence delirium (ED), and pain were measured using validated scales.
Main Results:
- Children using tablet games showed a trend towards lower anxiety levels at anesthetic induction (p=0.066).
- No significant differences were observed in the occurrence of emergence delirium (ED) or postoperative pain.
- Demographic and anesthetic variables were comparable between the tablet gaming and control groups.
Conclusions:
- Tablet gaming may offer a potential non-pharmacological strategy to reduce preoperative anxiety in pediatric surgical patients.
- The intervention did not significantly impact postoperative pain or emergence delirium.
- Further research and standardization of non-pharmacological interventions are needed to manage perioperative anxiety and pain effectively.
Purpose:
Children undergoing surgery and general anesthesia often experience preoperative anxiety (POA) with related negative short-, medium- and long-term consequences. Anxiolytic premedication has negative side effects, and nonpharmacologic interventions are often resource demanding and not always readily available in a busy clinical setting. The use of an age-appropriate game on a tablet computer may reduce POA, postoperative pain, and occurrence of emergence delirium (ED).
Design:
Children aged 3 to 6 years scheduled to undergo elective minor surgery were randomly assigned to play a game on a tablet computer while in the holding area before anesthesia (n = 30) or prepared as per departmental standard only (n = 30).
Methods:
POA, ED, and levels of pain were assessed by the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium, and Face, Legs, Activity, Cry, Consolability scale, respectively.
Findings:
A total of 60 children were randomized to either the intervention group or the control group. Gender, bodyweight, duration of anesthesia and surgery, and fentanyl dosages were comparable between the two groups. Tablet-gaming children tended to be less anxious than control subjects at the time of anesthesia induction (modified Yale Preoperative Anxiety Scale, 55.7 vs 65.8; 95% confidence interval, -0.63 to 20.8; P = .066). There was no difference in occurrence of ED or pain 20 minutes after arrival in the postanesthesia care unit.
Conclusions:
Although not statistically significant, the use of an age-appropriate tablet computer game may reduce the level of anxiety at the anesthetic induction in 3 to 6 years old children undergoing elective day-case surgery. However, the occurrence of ED and levels of pain appeared unaffected. Standardization of nonpharmacologic interventions to reduce perioperative anxiety and pain is required.
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