IPads Are As Effective As Conventional Sedatives For Lowering Anxiety In Children Before Surgery

Highlights

• Allowing children to use iPads before surgery helped to reduce their anxiety as effectively as pharmacological sedatives
• Children were assigned into two groups where one received a sedative while the other received a mobile interactive tool
• Post-operative anxiety was measured and found to be similar in parents and children in both groups.
• However, the quality of induction of anesthesia, as well as parental satisfaction, were judged better in the iPad group.

Allowing children to use iPads as a tool to distract them before surgery requiring general anesthesia is as effective as conventional sedatives in lowering their anxiety levels. Furthermore, the levels of parental satisfaction and quality of anesthesia induction was higher in children using iPads. The study was conducted by Dr Dominique Chassard, EPICIME, Hopital Mere Enfant, Hospices Civils de Lyon, Bron, France, and colleagues and presented at the World Congress of Anesthesiologists (WCA) in Hong Kong.

The aim of the study was to assess the effects of midazolam (a sedative used regularly before anesthesia to reduce fear and anxiety) in pre-medication and the effect of age-appropriate game apps (on an iPad tablet) on children aged 4-10 years during and after ambulatory (day) surgery. Anxiety was compared both in children and in parents.

Two groups were formed and children were randomly assigned in each group. The group that had 54 children received midazolam (MDZ) and the remaining 58 children were given the iPad (TAB).

Patients in group MDZ received midazolam 0.3mg/kg orally or rectally, and those in group TAB, were given an electronic tablet (iPAD) 20 minutes before anesthesia. Child anxiety was measured using m-YPAS scale which stands for modified Yale Preoperative Anxiety Scale. Two independent psychologists measured the levels at four time points- 1) at arrival at hospital 2) at separation from the parents 3) during induction and 4) in the post-anesthesia care unit (PACU).

Parental anxiety was measured using STAI score which stands for State-Trait Anxiety Inventory score, at similar time points except during induction as they were not present at that point. The quality of induction of anesthesia was ranked from 0 (not satisfied) to 10 (highly satisfied) by anesthetic nurses.

Parental anxiety and children anxiety were measured again finally when children were transferred to the ambulatory surgery ward, 30 minutes after the child received their last dose of nalbuphine anesthetic or 45 min after their arrival in the PACU.

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Post-operative behavior changes were assessed using the Post Hospital Behavior Questionnaire (PHBQ) and parents’ satisfaction with the anesthesia procedure was also ranked from 0 to 10.

In both MDZ and TAB groups, parents’ and children showed same anxiety levels with a similar pattern of evolution. Anesthesia was found to more satisfying in the iPad group by parents and nurses.

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Dr Chassard concludes "Our study showed that child and parental anxiety before anesthesia are equally blunted by midazolam or use of the iPad. However, the quality of induction of anesthesia, as well as parental satisfaction, were judged better in the iPad group. Use of iPads or other tablet devices is a non-pharmacologic tool which can reduce preoperative stress without any sedative effect in pediatric ambulatory surgery."

References:

1. iPads as effective as sedatives for children before operations - (http://www.eurekalert.org/pub_releases/2016-08/wfos-iae082516.php)
2. Measures of Anxiety - (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879951/)

Source-Medindia