iPads as sedatives for children
New research presented at this year's World Congress of
Anaesthesiologists (WCA) in Hong Kong (Aug. 28 - Sept. 2) shows that
allowing children to use iPads to distract them before surgery requiring
general anaesthesia is as effective at lowering their anxiety as
conventional sedatives. Furthermore, parental satisfaction and quality
of anaesthesia induction was higher in children using iPads. The study
is by Dr Dominique Chassard, EPICIME, Hopital Mere Enfant, Hospices
Civils de Lyon, Bron, France, and colleagues. Mobile interactive tools
have been found to be effective to reduce child anxiety at parental
separation in the operating theatre. The authors' aim in this study was
to compare the effects of midazolam (a sedative used regularly before
anaesthesia) in premedication with age-appropriate game apps (on an iPad
tablet) on children aged 4-10 years during and after ambulatory (day)
surgery.
Anxiety was assessed both in children and in parents. Children were
randomly allocated to one of the two groups (MDZ [midazolam-54 children]
or TAB [iPad - 58 children]). Patients in group MDZ received midazolam
0.3mg/kg orally or rectally, or, in group TAB, were given an electronic
tablet (iPAD) 20 min before anaesthesia.
Child anxiety (using m-YPAS scale) was measured by 2 independent
psychologists at four time points: 1) at arrival at hospital 2) at
separation from the parents 3) during induction and 4) in the post
anaesthesia care unit (PACU). Parental (using STAI score) anxiety was
measured at the same time points except during induction as they were
not present at that point. Anaesthetic nurses ranked from 0 (not
satisfied) to 10 (highly satisfied) the quality of induction of
anaesthesia. Then, 30 minutes after the child received their last dose
of nalbuphine anaesthestic or 45 min after arrival in the PACU, the
children were transferred to the ambulatory surgery ward where parental
anxiety (STAI 3) and children anxiety (m-YPAS 4) were again evaluated
for the final time.
In addition, parents' satisfaction with the anaesthesia procedure was
rated from 0 to 10. Postoperative behaviour changes were assessed with
the Post Hospital Behaviour Questionnaire (PHBQ). The researchers found
both parental and child anxiety levels to be similar in both groups,
with a similar pattern of evolution. Both parents and nurses found
anaesthesia more satisfying in the iPad group.
Dr Chassard concludes: "Our study showed that child and parental
anxiety before anaesthesia are equally blunted by midazolam or use of
the iPad. However, the quality of induction of anaesthesia, 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 perioperative stress without any sedative effect in paediatric
ambulatory surgery."
- MNT |