Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients

Jong-Hyuk Lee, Han-Kil Jung, Gang-Geun Lee, Han-Young Kim, Sun-Gyoo Park, Seong-Chang Woo, Jong-Hyuk Lee, Han-Kil Jung, Gang-Geun Lee, Han-Young Kim, Sun-Gyoo Park, Seong-Chang Woo

Abstract

Background: Children and parents experience significant anxiety and distress during the preoperative period. This is important because preoperative anxiety in children is associated with adverse postoperative outcome. So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application, world-widely used.

Methods: A total 120 patients (aged 1-10 years old) who were scheduled for elective surgery under general anesthesia was included in this randomized controlled trial. We randomized the patients into three groups, with using intravenous (IV) midazolam sedation (M group), with using smartphone application program (S group), and with using low dose IV midazolam plus smartphone application program (SM group). And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) at holding area, 5 min after intervention, entrance to operating room.

Results: In all three groups, mYPAS after intervention were lower than the preoperative holding area (M group 52.8 ± 11.8 vs 41.0 ± 7.0, S group 59.2 ± 17.6 vs 36.4 ± 7.3, SM group 58.3 ± 17.5 vs 26.0 ± 3.4). A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group (P < 0.01), and the SM group exhibited significantly lower anxiety than the two other groups (P < 0.01).

Conclusions: The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety.

Keywords: Anxiety; Child; Preoperative care.

Figures

Fig. 1
Fig. 1
(A) The change of preoperative anxiety by age in S group. (B) The change of preoperative anxiety by age in SM group. Values are mean of the modified Yale Preoperative Anxiety Scale (mYPAS). S group: intervention with smart phone application. SM group: midazolam 0.05 mg/kg IV premedication and intervention with smart phone application. mYPAS at 5 min after intervention, in operation room was lowered than mYPAS at holding area, but there is no specific tendency of mYPAS change by age. mYPAS at holding area tend to decrease as the age increased. Preoperative change of anxiety was influenced by age at holding area.
Fig. 2
Fig. 2
mYPAS of the group with experience was lower than mYPAS of the group without experience in S, SM group. Preoperative change of anxiety was influenced by familiarity with smartphone application. S group: Intervention with smartphone application. SM group: Midazolam premedication 0.05 mg/kg IV + Intervention with smartphone application. The group without experience: child who have not enjoyed playing smartphone application yet. The group with experience: child who have enjoyed playing smartphone application for more than a day. Values are mean mYPAS.

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