Allowing children to use iPads to distract them before surgery requiring general anaesthesia is as effective at lowering their anxiety as conventional sedatives, new research has shown.
Not only that, but the parent’s anxiety is lowered too — and the anaesthesia works better.
The research is by Dr Dominique Chassard and colleagues, and was presented at World Congress of Anaesthesiologists (WCA) in Hong Kong yesterday.
The aim of the study was to compare the effects of midazolam (a sedative used regularly before anaesthesia) in premedication with age-appropriate game apps on an iPad on children aged 4 to 10 years during and after day surgery. Anxiety levels were 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 iPad 20 minutes before anaesthesia.
Child anxiety was measured by two independent psychologists at four time points — on arrival at hospital, at separation from the parents, during induction and in the post anaesthesia care unit (PACU). Parental 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 minutes after arrival in the PACU, the children were transferred to the day surgery ward where parental anxiety and children anxiety 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.
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.
“Our study showed that child and parental anxiety before anaesthesia are equally blunted by midazolam or use of the iPad,”Dr Chassard concluded. “However, the quality of induction of anaesthesia, as well as parental satisfaction, were judged better in the iPad group”.
“The use of iPads or other tablet devices is therefore a non-pharmacologic tool which can reduce perioperative stress without any sedative effect in paediatric ambulatory surgery”.