Using Technology to Reduce Childrens’ Anxiety Throughout the Perioperative Period

Goldschmidt, K. & Woolley, A. Journal of Pediatric Nursing | Published online: 27 April 2017


In the U.S. each year, approximately 5 million children undergo a surgical procedure (Perry, Hooper, & Masiongale, 2012). Surgery is one of the most stressful medical procedures that a child can experience. In fact, approximately 50% of children are reported to experience significant anxiety in the preoperative period (Perry et al., 2012). Pediatric nurses know the importance of incorporating parents into the child’s plan of care and understand that the child is comforted by the presence of someone that they know and love.

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Translating e-pain research into patient care

McGuire, B.E. et al. (2017) Pain. 158(2) pp. 190–193


Recently, a call was made to expand the availability of pain self-management for the public, but several obstacles limit access to pain services such as distance, cost, and availability. Technology-based interventions can help with access to pain management, and consideration of these opportunities is timely given service pressures, changing consumer preferences, and the burgeoning ownership of personal computers and smartphones. In that context, we have described (1) the features of e-pain technologies, (2) the challenges in developing e-pain technologies, (3) the existing evidence in relation to technology-based pain management, (4) the debate regarding regulation of e-pain treatments, and (5) the likely steps for future development of these interventions.

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The application of three-dimensional printing technology in anaesthesia

Chao, I. et al. Anesthesia. Published online: 27 January 2017 


Three-dimensional printing has rapidly become an easily accessible, innovative and versatile technology, with a vast range of applications across a wide range of industries. There has been a recent emergence in the scientific literature relating to its potential application across a multitude of fields within medicine and surgery; however, its use within anaesthesia has yet to be formally explored. We undertook a systematic review using MEDLINE and EMBASE databases of three-dimensional printing in anaesthesia. We identified eight relevant articles. Due to the paucity of studies, we also completed a narrative review of the applications of three-dimensional printing pertinent to anaesthetic practice that our department are currently exploring, and suggest potential future uses for this technology relevant to our speciality.

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Smartphone-based behavioural intervention alleviates children’s anxiety during anaesthesia induction

Cumino, D. et al. European Journal of Anaesthesiology. Published online: 18 January 2017


Background: Preoperative anxiety negatively influences children’s anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children’s anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial.


Conclusions: The behavioural distraction strategies using smartphones were effective in preventing an increase in children’s anxiety during anaesthesia induction.

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Internet-Based Resources Frequently Provide Inaccurate and Out-of-Date Recommendations on Preoperative Fasting: A Systematic Review.

Roughead, T. et al. Anesthesia & Analgesia. Published online: September 16 2016


Preoperative fasting is important to avoid morbidity and surgery delays, yet recommendations available on the Internet may be inaccurate. Our objectives were to describe the characteristics and recommendations of Internet resources on preoperative fasting and assess the quality and readability of these websites.

We searched the Internet for common search terms on preoperative fasting using Google(R) search engines from 4 English-speaking countries (Canada, the United States, Australia, and the United Kingdom). We screened the first 30 websites from each search and extracted data from unique websites that provided recommendations on preoperative fasting. Website quality was assessed using validated tools (JAMA Benchmark criteria, DISCERN score, and Health on the Net Foundation code [HONcode] certification). Readability was scored using the Flesch Reading Ease score and Flesch-Kincaid Grade Level.

A total of 87 websites were included in the analysis. A total of 48 websites (55%) provided at least 1 recommendation that contradicted established guidelines. Websites from health care institutions were most likely to make inaccurate recommendations (61%). Only 17% of websites encouraged preoperative hydration. Quality and readability were poor, with a median JAMA Benchmark score of 1 (interquartile range 0-3), mean DISCERN score 39.8 (SD 12.5), mean reading ease score 49 (SD 15), and mean grade level of 10.6 (SD 2.7). HONcode certification was infrequent (10%). Anesthesia society websites and scientific articles had higher DISCERN scores but worse readability compared with websites from health care institutions.

Online fasting recommendations are frequently inconsistent with current guidelines, particularly among health care institution websites. The poor quality and readability of Internet resources on preoperative fasting may confuse patients.

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Tablet computers as effective as sedatives for children before operations

ScienceDaily | Published online: August 29, 2016


Mobile interactive tools have been found to be effective to reduce child anxiety at parental separation in the operating theatre. The authors’ aim in this study was to compare the effects of midazolam (a sedative used regularly before anaesthesia) in premedication with age-appropriate game apps (on an iPad tablet) on children aged 4-10 years during and after ambulatory (day) surgery. Anxiety was 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 electronic tablet (iPAD) 20 min before anaesthesia. Child anxiety (using m-YPAS scale) was measured by 2 independent psychologists at four time points: 1) at arrival at hospital 2) at separation from the parents 3) during induction and 4) in the post anaesthesia care unit (PACU). Parental (using STAI score) 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 min after arrival in the PACU, the children were transferred to the ambulatory surgery ward where parental anxiety (STAI 3) and children anxiety (m-YPAS 4) 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 (PHBQ).

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.

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