Visual Distraction During Sleep Induction with Propofol in Pediatric Patients – Can Cartoon Watching Influence the Sedative Dose?

Abstract

Background In general anesthesia, cartoon watching and playing video games reduce anxiety in children. It is unknown whether watching a video in the intervention room has a similar effect, and therefore is able to reduce sedative doses in children undergoing small medical procedures. Aim of this prospective study was to determine the effect of watching a standardized cartoon immediately before and during sleep induction for deep sedation on consumption of propofol in children.

Patients and Methods 50 children aged 2–14 years undergoing deep sedation were randomly assigned to 2 groups: (A) watching or (B) not watching a standardized videoclip during sleep induction with propofol. The achievement of predefined sedation depth was objectified by measuring Comfort Score (aim 10–14) and Bispectral Index (aim 50–60).

Results The median sleep induction dose of propofol did not differ in both groups (A: 1.76 (0.62–4.37) mg/kg; B: 1.37 (0.66–5.26) mg/kgKG; p=0.65). Cartoon watching was associated with shorter sleep onset latency (A: 120 (60–480)s; B: 240 (40–600)s; p=0.043). Subgroup analysis reveals this especially for school children and girls. In both groups no complications occurred.

Conclusion Children watching a standard cartoon during sleep induction for deep sedation have a shorter sleep onset time but sedative dose is not reduced.

Zusammenfassung

Hintergrund Vor und während der Einleitung einer Vollnarkose reduziert das Ansehen eines Cartoons oder das Spielen von Videospielen bei Kindern Angst. Es ist nicht bekannt, ob das auch im Zusammenhang mit Sedierungen gilt und die notwendige Sedativadosis für kleine Eingriffe oder Prozeduren bei Kindern durch das Ansehen eines Films reduziert werden kann. Ziel dieser prospektiven Studie war es deswegen, den Effekt zu ermitteln, den das Ansehen eines standardisierten Videos unmittelbar vor und während Schlafinduktion für eine tiefe Sedierung auf den Propofolbedarf bei Kindern hat.

Patienten und Methoden 50 Kinder zwischen 2 und 14 Jahren wurden in 2 Gruppen randomisiert, denen während medikamentöser Induktion mit Propofol für eine tiefe Sedierung entweder ein Standardfilm (Gruppe A) oder kein Film (Gruppe B) präsentiert wurde. Die gewünschte Schlaftiefe war definiert und wurde durch Erheben eines klinischen Scores (Comfort Score, Ziel 10–14) und den Einsatz von Bispektralem Index (Ziel 50–60) objektiviert.

Ergebnisse Die mediane Schlafinduktionsdosis für Propofol unterschied sich in beiden Gruppen nicht (A: 1,76 (0,62–4,37) mg/kg; B: 1,37 (0,66–5,26) mg/kgKG; p=0,65). Die Kinder, die einen Cartoon sahen, hatten eine kürzere Einschlafzeit (A: 120 (60–480)s; B: 240 (40–600)s; p=0,043). In der Subgruppenanalyse zeigt sich, dass dies insbesondere für Mädchen und Schulkinder gilt. In beiden Gruppen kam es zu keinerlei Komplikationen.

Schlussfolgerung Kinder, die während Sedierungseinleitung einen Film ansehen, haben eine kürzere Einschlafzeit, die Dosis der notwendigen Sedativa ist jedoch unbeeinflusst.

Key words

sedation - sedative dose - children - cartoon - distraction

Schlüsselwörter

Sedierung - Sedativadosis - Kinder - Film - Ablenkung

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