P086: ANXIOLYSIS WITH INTERACTIVE ANESTHESIA VIDEO GAMES IN A VISUALLY IMPAIRED PATIENT: THE IMPORTANCE OF CONSIDERING ACCESSIBILITY IN PERIOPERATIVE IMMERSIVE TECHNOLOGIES.
Christina C Moore, MD; Catalina Coppola, MD; Vincent R Sferra; Alana Miro; Alecia Sabartinelli Stein, MD; Department of Pediatric Anesthesiology, University of Miami, Holtz Children's Hospital, Miami, FL
Introduction: Preoperative anxiety in children is associated with a higher incidence of postoperative delirium, pain, anxiety, and sleep disturbances.(1) Immersive technologies, including interactive video game projection through the Bedside Entertainment and Relaxation Theater (BERT), improve perioperative anxiety, induction times, and satisfaction scores.(2) We present a novel application in children with visual deficits, who have been previously excluded from other technology based anxiolytic techniques due to a presumed lack of feasibility.
Case Presentation: A 5-year-old male with right iris stromal cyst, corneal edema, photophobia, and decreased vision presented for exam under anesthesia (EUA). His parent reported anxiety and resistance to prior examinations, so we offered an interactive video game built on the BERT platform. He remained alert and anxious even after he received preoperative oral midazolam (0.5 mg/kg) and was brought to the OR with parental presence. A screen projected the “Sevo the Dragon” game (courtesy of CHARIOT Stanford), and he selected a dragon and food choice to be cooked by the dragon’s fire. While he eagerly held his facemask, he was prompted to breathe deeply and roar to trigger the dragon to breathe fire. During this time, sevoflurane was administered incrementally until unconsciousness was achieved in a smooth, uncomplicated fashion. After completion of the procedure, he was brought to recovery without evidence of delirium or need for postoperative analgesics or anxiolytics. On his subsequent visit to the OR for repeated EUA and surgical cyst excision, we successfully utilized this technology again, much to his enjoyment and the satisfaction of his father, who observed marked improvement in demeanor compared to past experiences.
Discussion: The use of interactive video games provides a non-pharmacologic option to improve the perioperative experience of children undergoing invasive procedures. (3)Pediatric populations with visual deficits are commonly excluded from technology based anxiolytics, presumably due to concerns of limited interaction and diminished benefit. In patients with visual deficits, the auditory, social, and tactile components of the experience are critical. Furthermore, patients with sensory deficits typically undergo repeated anesthetic exposures. These patients are thus at increased risk of developing perioperative anxiety and may significantly benefit from immersive technologies.
Conclusion: Our case describes two uses of an interactive video game utilizing BERT technology during mask induction of a patient with visual deficits. We have successfully used these technologies in numerous patients with visual deficits by focusing on the auditory, tactile, and social aspects of the game emphasizing the importance of considering accessibility when designing perioperative anxiolytic tools.
1.Kain, Z.N., et al., Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics, 2006. 118(2): p. 651-8.
2.Caruso, T.J., et al., A Retrospective Review of a Bed-mounted Projection System for Managing Pediatric Preoperative Anxiety. Pediatr Qual Saf, 2018. 3(4): p. e087.
3.Kerimoglu, B., et al., Anesthesia induction using video glasses as a distraction tool for the management of preoperative anxiety in children. Anesth Analg, 2013. 117(6): p. 1373-9.