title: Distraction with a hand-held video game reduces pediatric preoperative anxiety.
abstract: BACKGROUND
  Video games have received widespread application in health care for distraction and behavior modification therapy. Studies on the effect of cognitive distraction during the preoperative period are lacking. We evaluated the efficacy of an interactive distraction, a hand-held video game (VG) in reducing preoperative anxiety in children.
  
  
  METHODS
  In a randomized, prospective study of 112 children aged 4-12 years undergoing outpatient surgery, anxiety was assessed after admission and again at mask induction of anesthesia, using the modified Yale Preoperative Anxiety Scale (mYPAS). Postoperative behavior changes were assessed with the Posthospital Behavior Questionnaire (PHBQ). Patients were randomly assigned to three groups: parent presence (PP), PP+a hand-held VG, and PP+0.5 mg.kg-1 oral midazolam (M) given>20 min prior to entering the operating room.
  
  
  RESULTS
  There was a statistically significant increase in anxiety (P<0.01) in groups M and PP at induction of anesthesia compared with baseline, but not in VG group. VG patients demonstrated a decrease in anxiety from baseline (median change in mYPAS -3), the difference compared with PP (+11.8) was significant (P=0.04). The change in anxiety in the M group (+7.3) was not statistically different from other groups. Sixty-three percent of patients in VG group had no change or decrease in anxiety after treatment, compared with 26% in M group and 28% in PP group (P=0.01). There was no difference in anxiety changes between female and male patients.
  
  
  CONCLUSIONS
  A hand-held VG can be offered to most children as a low cost, easy to implement, portable, and effective method to reduce anxiety in the preoperative area and during induction of anesthesia. Distraction in a pleasurable and familiar activity provides anxiety relief, probably through cognitive and motor absorption.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA. patelan@umdnj.edu
authors.forename: Anuradha
authors.initials: A
authors.lastname: Patel
authors.forename: Thomas
authors.initials: T
authors.lastname: Schieble
authors.forename: Melissa
authors.initials: M
authors.lastname: Davidson
authors.forename: Minh C J
authors.initials: MC
authors.lastname: Tran
authors.forename: Catherine
authors.initials: C
authors.lastname: Schoenberg
authors.forename: Ellise
authors.initials: E
authors.lastname: Delphin
authors.forename: Henry
authors.initials: H
authors.lastname: Bennett
mesh_terms: D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General / Q000523:psychology*; D001007:Anxiety / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D011300:Preoperative Care / Q000523:psychology*; D011446:Prospective Studies; D011594:Psychometrics; D012727:Sex Characteristics; D011795:Surveys and Questionnaires; D018910:Video Games
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam