Poster - Society for Pediatric Anesthesia

Tablet based interactive distraction for anxiolysis during parental separation and induction of anesthesia
Samuel C. Seiden MD1, Chris Heddon DO2, Susan McMullan CRNA1, Audrey Rosenblatt CRNA1, Santhanam Suresh, MD1
OPTIONAL
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1-Department of Anesthesiology – Ann and Robert H. Lurie Children’s Hospital of Chicago – Northwestern University Feinberg School of Medicine, Chicago, IL
2-Department of Anesthesia and Critical Care – Rush University Medical Center - Chicago, IL
Background
•  Parental separation and induction of
anesthesia are major sources for anxiety
and stress in pediatric patients. •  This stress can cause behavioral changes
that even parallel post-traumatic stress
disorder (PTSD)
•  Techniques for alleviating such anxiety
include sedating medications, parental
presence during induction, and a variety
of distraction techniques including video
games (VG)
•  Previous studies have demonstrated video
games as effective as midazolam for
anxiolysis
•  VGs provide powerful distraction tool as
interactive nature consumes attention
•  Tablet computing offers unique
advantages over other VG systems
including:
•  Storage for hundreds of
developmentally appropriate low
cost games on one device that can be
easily changed.
•  Source for other distraction media
(eBooks, videos)
•  Intuitive gesture based interface.
•  Age appropriateness and utility down
to age 1 (younger than non-tablet
based VGs can accomplish).
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•  Tablet arm receives 16 GB Wi-Fi iPad
Mini ($329) (Apple Computers,
Cupertino, CA)
•  Modified Yale Preoperative Anxiety
Scale (mYPAS) scored before separation,
at separation, and at induction.
•  Parents surveyed to satisfaction with
separation and their impression of child’s
baseline anxeity. •  Patient is allowed to choose from a
variety of developmentally appropriate
video games (see table)
•  Post operatively emergence delirium
scale (PAED) assessed in PACU at 0 and
15 minute intervals.
•  Postoperative behavioral dysfunction
assessed at 7 and 14 days by telephone
using the post-hospitalization behavior
questionnaire (PHBQ).
Screenshots of Fruit
Ninja (top left); Race
Penguin (bottom left)
and Talking Tom
(bottom right)
Game Selection Examples
Game
Age range
Pocket Pond
1-3
Splashing water and fishes in realistic Koi pond. Great for infants and
toddlers. Talking Tom
1-6
Kitty cat repeats back what you say and does interactive tricks
Fruit Ninja
1-11
Finger slice and dice flying fruit. Very addictive and fun for toddlers
to teenagers
Angry Birds
4-11
Slingshot birds to knock down pigs and their fortresses
Bad Piggies
4-11
Strategic pig cart building and racing
Cut the Rope
4-11
Puzzles to drop candy pieces into waiting frogs mouth
Racing Penguin
4-11
Race penguin up and down snow slopes against time clock
Temple Run
4-11
Fast paced temple racing adventure; dodging adversaries
Lego games
4-11
Virtual Lego building and interactive games
I Hear Ewe
1-3
Tiles of animals and objects and their respective sounds (planes, trains
etc) in different languages. E.g. “This is the sound a duck makes”
Color Studio HD
1-11
Virtual drawing studio
(years)
Description
Discussion
•  TBID is effective as a sole or as an
adjunct option for perioperative anxiolysis
•  Current research investigating use of
TBID vs. pharmacologic anxiolysis in key
metrics such as anxiety scores, time to
discharge, emergence delirium, postoperative behavior dysfunction, and others.
•  Device acquisition cost higher than other
options but greater flexibility
Angry Birds (top left)
Temple Run (bottom
left). Toddler playing
Game during
Induction (bottom
right
References
• 
Methods
•  Eligible subjects: Age 1-11 years; ASA 1-2;
outpatient surgery; first time anesthetic; no
developmental or psychiatric diagnoses
•  Participants randomized to receive tablet
based interactive distraction (TBID) vs. oral
versed 0.5 mg/kg to max 20 mg
•  Parental presence excluded from study
TEMPLATE DESIGN © 2008
• 
Results
• 
• 
• 
Data collection began 2/9/2013
Results to date will be presented at
conference
Goal for 102 subjects enrolled in 3 age
cohorts
• 
• 
Young child plays game during anesthesia induction. Note that sitting position affords more comfortable game
play. Screenshot of Pocket Pond at right.
• 
Kain, Z. N., et al. (1997). The Yale Preoperative Anxiety
Scale: how does it compare with a “gold standard”? Anesth
Analg, 85(4):783-8.
Patel, A., et al. (2006), Distraction with a hand-held video
game reduces pediatric preoperative anxiety. Pediatric
Anesthesia, 16: 1019–1027.
McQueen, A., et al. (2012), Using a tablet computer during
pediatric procedures: a case series and review of the “apps”.
Pediatric Emergency Care, 28(7):712-714.
Kain, Z. N., et al. (2006), Preoperative anxiety,
postoperative pain and behavioral recovery in young
children undergoing surgery. Pediatrics, 118(2):651-8. Cohen JA, Mannarino AP. Psychotherapeutic options for
traumatized children. Curr Opin Pediatr. 2010 Oct;22(5):
605-9.