|
 “Anxiety is a major source of concern for children going to the
hospital for anything, but especially for surgery and it’s also a
major source of dissatisfaction for their parents,” said lead author
Dr. Samuel C. Seiden. “That whole process of leaving parents or
having someone put a mask over your face can be a very traumatic
experience.
“That’s why we spent a lot of time thinking about how we could make
this less anxiety-provoking for children,” said Seiden, a professor
of pediatric anesthesiology at Northwestern University Feinberg
School of Medicine in Chicago.
Many hospitals have reported using music, videos and games to
distract kids from their fears in recent years, sometimes as an
alternative to sedation, Seiden told Reuters Health.
He and his team wanted to test the iPad mini as a distraction method
because it is interactive and easy to use.
For the study, which is published in the journal Pediatric
Anesthesia, 108 kids ages 1 to 11 years old were randomly assigned
to receive either oral midazolam syrup - a sedative similar to
valium or xanax - or an Apple iPad mini before going under
anesthesia for surgery.
Kids who received the iPad chose an age-appropriate game and started
playing with it when it was time to leave their parents to go for
preoperative anesthesia, and could play right up until the time they
received the anesthesia.
The other group received the sedative at least 15 minutes before
anesthesia.
Researchers found that kids ages 1-11 who played with the tablet
showed a 9-point decrease in anxiety (on a scale of 100) when they
separated from their parents compared to kids who received the
sedation.
Kids ages 2-11 who played with the tablet when anesthesia was first
being administered showed a 14-point decrease in anxiety compared to
the kids who got a sedative.
Recovery room stay was also shorter by almost half in the tablet
group (87 minutes in the tablet group versus 111 minutes in the
midazolam group). The study also found that 81 percent of parents in
the tablet group were very satisfied with the separation compared to
59 percent in the sedative group.
“It used to be very common to give kids under 8 a sedating
medication but now our default practice is, if the kid is over 4, we
expect we can distract with a tablet,” Seiden said. (A video
demonstrating how the tablet would be used with a child before
anesthesia can be viewed here: http://bit.ly/1oDCaqR).
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Side effects of midazolam syrup can include shallow breathing,
airway obstruction and nausea, although Seiden said the drug has a
low rate of allergic reactions. But, he added, the drug does not
always work and can sometimes cause agitation.
Alisa McQueen, assistant professor of pediatrics and director of the
pediatric emergency medicine fellowship program at The University of
Chicago, told Reuters Health that iPads are a popular distraction
method used throughout Comer Children’s Hospital, where she works.
She recalled an infant who was calmed by an app that played womb
sounds during a lumbar puncture. McQueen is researching the use of
iPads as a distraction method for kids in the ER.
“The iPad is unique in how interactive it can be, and how we can
adapt it to different children’s age/developmental level/personal
preference,” McQueen wrote in an email. But, McQueen cautioned, the
distraction isn’t a cure-all.
“The iPad is incredibly effective, but it isn’t magic and doesn’t
work for all kids,” she said. “So it’s quite unusual to have a kid
truly terrified - screaming and uncooperative - who is instantly
calmed by the distraction.”
McQueen noted that a table included in the study report with
suggested apps and programs by age would be an important resource
for doctors interested in using tablets for distraction.
“A small study like this one isn’t the end-all be-all, of course,
but it certainly contributes to a growing literature that
tablet-based distraction is a worthy alternative - and ultimately
may even be superior - to midazolam,” McQueen said.
SOURCE: http://bit.ly/V1Pcmf Pediatric Anesthesia, online July 17,
2014.
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