Distraction with a Hand Held Video Game is as Effective as Premedication in Reducing Preoperative Anxiety
M.C.J. Tran, MD, MPH, A. Patel, MD, T. Schieble, MD, MBA, M. Davidson, MD, C. Schoenberg, RN, H. Bennett, Ph D, E. Delphin, MD, MPH
Department of Anesthesiology, UMDNJ, New Jersey Medical School, Newark, NJ

Introduction:
Video game playing has become a ubiquitous activity in society today. There are no studies documenting the effect of cognitive distraction during the preoperative period and the induction of general anesthesia in the pediatric population. This prospective randomized controlled trial examined whether being involved with an interactive distraction ie. GameBoy, is as effective as medication with midazolam in reducing preoperative anxiety, in children ages 4-12 years.
Methods:
A prospective randomized controlled trial of three interventions affecting pre-anesthetic anxiety was conducted in children undergoing general anesthesia for elective outpatient surgery in an ambulatory surgery center. Parents or guardians of 78 patients aged 4-12 yrs with ASA physical status of I-II were evaluated and informed consent to participate was obtained. Subjects were stratified by age and were randomly assigned to one of the three groups: a baseline parental presence only (P), parent and midazolam (M), parent and a distraction technique (a handheld video game [GameBoyTM]) (GB). A trained research
nurse then completed the modified Yale Preoperative Anxiety Scale (mYPAS) to quantify children’s anxiety prior to any intervention. This served as the baseline mYPAS score. At least twenty minutes after administration of the intervention (midazolam, GameBoy, none), parent and patient were escorted into the operating. Patients assigned to the GameBoy were allowed to play the game until the mask was introduced. For all groups, just prior to the time of mask induction, a second anxiety assessment using the mYPAS was recorded.
Results:
The median baseline mYPAS scores were not significantly different at baseline among groups (Table 1). Under the conditions of the study we found that children ages 4-12yrs had significantly less change in anxiety from preoperative holding area to mask induction of general anesthesia in the group which played with the GameBoy (Kruskal Wallis ANOVA, p=0.01). The MEDIAN change in anxiety for the GameBoy group was 0 (no change) while for midazolam the increase was 7.5 mYPAS units and for parental presence alone, the increase was 17.5 mYPAS units (Table 2). Age also was significantly related to change in
anxiety, with younger children (age 4-6 and 7-9) having greater pre-induction anxiety than the older children (age 10-12).
Table 1: Demographics and baseline characteristics of the study sample of 78 pediatric patients for outpatient surgery.

Table 2: Change in mYPAS units from baseline to just prior to induction of anesthesia by group.

Conclusion: This study shows that use of a distraction with a hand held video game, GameBoy, is as effective in reducing preoperative anxiety in children as premedication.

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