Department of Anaesthesiology and Intensive Care, University Hospital Odense, Odense, Denmark; Department of Clinical Research - Anaesthesiology, University of Southern Denmark, Odense, Denmark.
Department of Anaesthesiology and Intensive Care, University Hospital Odense, Odense, Denmark; Department of Clinical Research - Anaesthesiology, University of Southern Denmark, Odense, Denmark.
J Perianesth Nurs. 2021 Jun;36(3):275-278. doi: 10.1016/j.jopan.2020.09.012. Epub 2021 Feb 23.
Children undergoing surgery and general anesthesia often experience preoperative anxiety (POA) with related negative short-, medium- and long-term consequences. Anxiolytic premedication has negative side effects, and nonpharmacologic interventions are often resource demanding and not always readily available in a busy clinical setting. The use of an age-appropriate game on a tablet computer may reduce POA, postoperative pain, and occurrence of emergence delirium (ED).
Children aged 3 to 6 years scheduled to undergo elective minor surgery were randomly assigned to play a game on a tablet computer while in the holding area before anesthesia (n = 30) or prepared as per departmental standard only (n = 30).
POA, ED, and levels of pain were assessed by the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium, and Face, Legs, Activity, Cry, Consolability scale, respectively.
A total of 60 children were randomized to either the intervention group or the control group. Gender, bodyweight, duration of anesthesia and surgery, and fentanyl dosages were comparable between the two groups. Tablet-gaming children tended to be less anxious than control subjects at the time of anesthesia induction (modified Yale Preoperative Anxiety Scale, 55.7 vs 65.8; 95% confidence interval, -0.63 to 20.8; P = .066). There was no difference in occurrence of ED or pain 20 minutes after arrival in the postanesthesia care unit.
Although not statistically significant, the use of an age-appropriate tablet computer game may reduce the level of anxiety at the anesthetic induction in 3 to 6 years old children undergoing elective day-case surgery. However, the occurrence of ED and levels of pain appeared unaffected. Standardization of nonpharmacologic interventions to reduce perioperative anxiety and pain is required.
接受手术和全身麻醉的儿童常经历术前焦虑（POA），并伴有相关的短期、中期和长期负面影响。镇静前用药有副作用，而非药物干预措施往往需要大量资源，而且在繁忙的临床环境中并不总是随时可用。在平板电脑上使用适合年龄的游戏可能会降低 POA、术后疼痛和出现术后谵妄（ED）的发生率。
选择年龄在 3 至 6 岁、计划接受择期小手术的儿童，在麻醉前的等候区随机分配到平板电脑上玩游戏（n=30）或仅按部门标准准备（n=30）。
通过改良耶鲁术前焦虑量表、儿科麻醉苏醒期谵妄量表和面部、腿部、活动、哭泣、安抚量表分别评估 POA、ED 和疼痛程度。
共有 60 名儿童被随机分配到干预组或对照组。两组儿童的性别、体重、麻醉和手术时间以及芬太尼剂量无差异。与对照组相比，玩游戏的儿童在麻醉诱导时的焦虑程度较低（改良耶鲁术前焦虑量表，55.7 分 vs 65.8 分；95%置信区间，-0.63 至 20.8；P=0.066）。在到达麻醉后恢复室后 20 分钟，ED 或疼痛的发生率无差异。
虽然没有统计学意义，但在接受择期日间手术的 3 至 6 岁儿童中，使用适合年龄的平板电脑游戏可能会降低麻醉诱导时的焦虑水平。然而，ED 的发生和疼痛程度似乎没有受到影响。需要标准化非药物干预措施以减轻围手术期焦虑和疼痛。
