Rodriguez Samuel T, Jang Olivia, Hernandez Jessica Maya, George Alexandria Joseph, Caruso Thomas J, Simons Laura E
Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
Paediatr Anaesth. 2019 Jun;29(6):648-655. doi: 10.1111/pan.13636. Epub 2019 Apr 14.
Preoperative anxiety affects up to 65% of children who undergo anesthesia induction and often results in uncooperative behavior. Electronic devices have been used to distract children to reduce anxiety and create a more enjoyable preoperative experience. Few studies have compared the effects of different video delivery systems on preoperative anxiety.
The primary aim was to determine if a large projection-based video screen mounted to a patient's bed decreased anxiety when compared to a tablet during mask induction of anesthesia in children from 4-10 years of age.
We performed a prospective, randomized trial to determine differences in our primary outcome, preoperative anxiety, between the large Bedside Entertainment and Relaxation Theater (BERT) and a smaller tablet screen. Secondary outcomes included (a) induction compliance; (b) child fear; (c) frequency of emergence delirium; and (d) satisfaction.
In examining the primary outcome for 52 patients, there was a main effect for time on mYPAS scores, f(2, 51) = 13.18, P < 0.01. mYPAS scores significantly increased across time for both groups. The interaction for time (T0, T1 or T2) × group (BERT vs Tablet) was not significant, f(2, 51) = 1.96, P = 0.15; thus changes in mYPAS scores across time did not differ by group status. There was no significant difference in induction compliance, child fear, emergence delirium, or satisfaction between the two groups.
In a low-risk population, preoperative anxiety was low and induction compliance was high when pairing screen-based distraction interventions, regardless of size, with parental presence at induction of anesthesia.
术前焦虑影响多达65%接受麻醉诱导的儿童，常导致不合作行为。电子设备已被用于分散儿童注意力，以减轻焦虑并创造更愉快的术前体验。很少有研究比较不同视频播放系统对术前焦虑的影响。
主要目的是确定在4至10岁儿童面罩诱导麻醉期间，与平板电脑相比，安装在患者床上的大型投影视频屏幕是否能降低焦虑。
我们进行了一项前瞻性随机试验，以确定主要结局（术前焦虑）在大型床边娱乐与放松影院（BERT）和较小的平板电脑屏幕之间的差异。次要结局包括：（a）诱导依从性；（b）儿童恐惧；（c）苏醒期谵妄的发生率；（d）满意度。
在检查52例患者的主要结局时，时间对改良耶鲁术前焦虑量表（mYPAS）评分有主效应，F(2, 51) = 13.18，P < 0.01。两组的mYPAS评分均随时间显著增加。时间（T0、T1或T2）×组（BERT与平板电脑）的交互作用不显著，F(2, 51) = 1.96，P = 0.15；因此，mYPAS评分随时间的变化在两组间无差异。两组在诱导依从性、儿童恐惧、苏醒期谵妄或满意度方面无显著差异。
在低风险人群中，当在麻醉诱导时将基于屏幕的分心干预措施（无论大小）与家长在场相结合时，术前焦虑较低且诱导依从性较高。
