Tablet based interactive distraction for anxiolysis during ... · PDF fileTablet based...
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TEMPLATE DESIGN © 2008 www.PosterPresentations.com Tablet based interactive distraction for anxiolysis during parental separation and induction of anesthesia Samuel C. Seiden MD 1 , Chris Heddon DO 2 , Susan McMullan CRNA 1 , Audrey Rosenblatt CRNA 1 , Santhanam Suresh, MD 1 1-Department of Anesthesiology – Ann and Robert H. Lurie Children’s Hospital of Chicago – Northwestern University Feinberg School of Medicine, Chicago, IL 2-Department of Anesthesia and Critical Care – Rush University Medical Center - Chicago, IL Background References OPTIONAL LOGO HERE Game Selection Examples Discussion Methods • Tablet arm receives 16 GB Wi-Fi iPad Mini ($329) (Apple Computers, Cupertino, CA) • Modified Yale Preoperative Anxiety Scale (mYPAS) scored before separation, at separation, and at induction. • Parents surveyed to satisfaction with separation and their impression of child’s baseline anxeity. • Patient is allowed to choose from a variety of developmentally appropriate video games (see table) • Post operatively emergence delirium scale (PAED) assessed in PACU at 0 and 15 minute intervals. • Postoperative behavioral dysfunction assessed at 7 and 14 days by telephone using the post-hospitalization behavior questionnaire (PHBQ). • TBID is effective as a sole or as an adjunct option for perioperative anxiolysis • Current research investigating use of TBID vs. pharmacologic anxiolysis in key metrics such as anxiety scores, time to discharge, emergence delirium, post- operative behavior dysfunction, and others. • Device acquisition cost higher than other options but greater flexibility • Kain, Z. N., et al. (1997). The Yale Preoperative Anxiety Scale: how does it compare with a “gold standard”? Anesth Analg, 85(4):783-8. • Patel, A., et al. (2006), Distraction with a hand-held video game reduces pediatric preoperative anxiety. Pediatric Anesthesia, 16: 1019–1027. • McQueen, A., et al. (2012), Using a tablet computer during pediatric procedures: a case series and review of the “apps”. Pediatric Emergency Care, 28(7):712-714. • Kain, Z. N., et al. (2006), Preoperative anxiety, postoperative pain and behavioral recovery in young children undergoing surgery. Pediatrics, 118(2):651-8. • Cohen JA, Mannarino AP. Psychotherapeutic options for traumatized children. Curr Opin Pediatr. 2010 Oct;22(5): 605-9. Game Age range (years) Description Pocket Pond 1-3 Splashing water and fishes in realistic Koi pond. Great for infants and toddlers. Talking Tom 1-6 Kitty cat repeats back what you say and does interactive tricks Fruit Ninja 1-11 Finger slice and dice flying fruit. Very addictive and fun for toddlers to teenagers Angry Birds 4-11 Slingshot birds to knock down pigs and their fortresses Bad Piggies 4-11 Strategic pig cart building and racing Cut the Rope 4-11 Puzzles to drop candy pieces into waiting frogs mouth Racing Penguin 4-11 Race penguin up and down snow slopes against time clock Temple Run 4-11 Fast paced temple racing adventure; dodging adversaries Lego games 4-11 Virtual Lego building and interactive games I Hear Ewe 1-3 Tiles of animals and objects and their respective sounds (planes, trains etc) in different languages. E.g. “This is the sound a duck makes” Color Studio HD 1-11 Virtual drawing studio • Parental separation and induction of anesthesia are major sources for anxiety and stress in pediatric patients. • This stress can cause behavioral changes that even parallel post-traumatic stress disorder (PTSD) • Techniques for alleviating such anxiety include sedating medications, parental presence during induction, and a variety of distraction techniques including video games (VG) • Previous studies have demonstrated video games as effective as midazolam for anxiolysis • VGs provide powerful distraction tool as interactive nature consumes attention • Tablet computing offers unique advantages over other VG systems including: • Storage for hundreds of developmentally appropriate low cost games on one device that can be easily changed. • Source for other distraction media (eBooks, videos) • Intuitive gesture based interface. • Age appropriateness and utility down to age 1 (younger than non-tablet based VGs can accomplish). • Eligible subjects: Age 1-11 years; ASA 1-2; outpatient surgery; first time anesthetic; no developmental or psychiatric diagnoses • Participants randomized to receive tablet based interactive distraction (TBID) vs. oral versed 0.5 mg/kg to max 20 mg • Parental presence excluded from study Results • Data collection began 2/9/2013 • Results to date will be presented at conference • Goal for 102 subjects enrolled in 3 age cohorts Screenshots of Fruit Ninja (top left); Race Penguin (bottom left) and Talking Tom (bottom right) Angry Birds (top left) Temple Run (bottom left). Toddler playing Game during Induction (bottom right Young child plays game during anesthesia induction. Note that sitting position affords more comfortable game play. Screenshot of Pocket Pond at right.
Transcript of Tablet based interactive distraction for anxiolysis during ... · PDF fileTablet based...
TEMPLATE DESIGN © 2008 www.PosterPresentations.com
Tablet based interactive distraction for anxiolysis during parental separation and induction of anesthesia
Samuel C. Seiden MD1, Chris Heddon DO2, Susan McMullan CRNA1, Audrey Rosenblatt CRNA1, Santhanam Suresh, MD1
1-Department of Anesthesiology – Ann and Robert H. Lurie Children’s Hospital of Chicago – Northwestern University Feinberg School of Medicine, Chicago, IL 2-Department of Anesthesia and Critical Care – Rush University Medical Center - Chicago, IL
Background
References
OPTIONAL LOGO HERE
Game Selection Examples Discussion
Methods
• Tablet arm receives 16 GB Wi-Fi iPad Mini ($329) (Apple Computers, Cupertino, CA) • Modified Yale Preoperative Anxiety Scale (mYPAS) scored before separation, at separation, and at induction. • Parents surveyed to satisfaction with separation and their impression of child’s baseline anxeity. • Patient is allowed to choose from a variety of developmentally appropriate video games (see table) • Post operatively emergence delirium scale (PAED) assessed in PACU at 0 and 15 minute intervals. • Postoperative behavioral dysfunction assessed at 7 and 14 days by telephone using the post-hospitalization behavior questionnaire (PHBQ).
• TBID is effective as a sole or as an adjunct option for perioperative anxiolysis • Current research investigating use of TBID vs. pharmacologic anxiolysis in key metrics such as anxiety scores, time to discharge, emergence delirium, post-operative behavior dysfunction, and others. • Device acquisition cost higher than other options but greater flexibility
• Kain, Z. N., et al. (1997). The Yale Preoperative Anxiety Scale: how does it compare with a “gold standard”? Anesth Analg, 85(4):783-8.
• Patel, A., et al. (2006), Distraction with a hand-held video game reduces pediatric preoperative anxiety. Pediatric Anesthesia, 16: 1019–1027.
• McQueen, A., et al. (2012), Using a tablet computer during pediatric procedures: a case series and review of the “apps”. Pediatric Emergency Care, 28(7):712-714.
• Kain, Z. N., et al. (2006), Preoperative anxiety, postoperative pain and behavioral recovery in young children undergoing surgery. Pediatrics, 118(2):651-8.
• Cohen JA, Mannarino AP. Psychotherapeutic options for traumatized children. Curr Opin Pediatr. 2010 Oct;22(5):605-9.
Game Age range���(years)
Description
Pocket Pond 1-3 Splashing water and fishes in realistic Koi pond. Great for infants and toddlers.
Talking Tom 1-6 Kitty cat repeats back what you say and does interactive tricks
Fruit Ninja 1-11 Finger slice and dice flying fruit. Very addictive and fun for toddlers to teenagers
Angry Birds 4-11 Slingshot birds to knock down pigs and their fortresses
Bad Piggies 4-11 Strategic pig cart building and racing
Cut the Rope 4-11 Puzzles to drop candy pieces into waiting frogs mouth
Racing Penguin 4-11 Race penguin up and down snow slopes against time clock
Temple Run 4-11 Fast paced temple racing adventure; dodging adversaries
Lego games 4-11 Virtual Lego building and interactive games
I Hear Ewe 1-3 Tiles of animals and objects and their respective sounds (planes, trains etc) in different languages. E.g. “This is the sound a duck makes”
Color Studio HD 1-11 Virtual drawing studio
• Parental separation and induction of anesthesia are major sources for anxiety and stress in pediatric patients.
• This stress can cause behavioral changes that even parallel post-traumatic stress disorder (PTSD)
• Techniques for alleviating such anxiety include sedating medications, parental presence during induction, and a variety of distraction techniques including video games (VG)
• Previous studies have demonstrated video games as effective as midazolam for anxiolysis
• VGs provide powerful distraction tool as interactive nature consumes attention
• Tablet computing offers unique advantages over other VG systems including: • Storage for hundreds of
developmentally appropriate low cost games on one device that can be easily changed.
• Source for other distraction media (eBooks, videos)
• Intuitive gesture based interface. • Age appropriateness and utility down
to age 1 (younger than non-tablet based VGs can accomplish).
• Eligible subjects: Age 1-11 years; ASA 1-2; outpatient surgery; first time anesthetic; no developmental or psychiatric diagnoses • Participants randomized to receive tablet based interactive distraction (TBID) vs. oral versed 0.5 mg/kg to max 20 mg • Parental presence excluded from study
Results • Data collection began 2/9/2013 • Results to date will be presented at
conference • Goal for 102 subjects enrolled in 3 age
cohorts
Screenshots of Fruit Ninja (top left); Race Penguin (bottom left) and Talking Tom (bottom right)
Angry Birds (top left) Temple Run (bottom left). Toddler playing Game during Induction (bottom right
Young child plays game during anesthesia induction. Note that sitting position affords more comfortable game play. Screenshot of Pocket Pond at right.
