handheld-multimedia versus oral midazolam in pediatric on perioperative anxiety

Conditions: Perioperative Anxiety; Preanesthetic Medication; Inhalation Anesthesia; Ambulatory Surgery; Tonsillectomy; Circumcision; Dental Care

Summary: the first goal of this study is to compare the efficacy and safety between anxiolysis by multimedia-distraction with an ipad versus anxiolysis by premedication with midazolam prior to the induction. secondly to evaluate the need for midazolam-premedication in pediatric day-care patients induced by inhalational anesthesia.

perioperative anxiety in children is a common multifactorial influenced and triggered entity with an incidence as high as 50%. especially (mask)induction of anesthesia is considered one of the most stressful experiences for a child undergoing surgery. a common practice worldwide to diminish the level of anxiety prior to anesthesia is premedication with the benzodiazepine midazolam in order to improve cooperation during induction. premedication with midazolam has a primary purpose to reduce preoperative anxiety and has inherent to a benzodiazepine its sedative effects. although these effects are implied, negative effects of premedication: respiratory complications, paradoxical negative behavior has been reported. although alternative medications have been studied, studies for non-pharmacological anxiety-reduction remain limited. non-pharmacological anxiety-reduction by distraction including tablet or ipad-multimedia might be a readily available alternative for midazolam premedication. potentially limiting the use of psychoactive agents, limiting the need for preoperative sedation and therefore possibly decrease secondary respiratory complications in pediatric surgical day-care. objective: the first goal of this study is to compare the efficacy and safety between anxiolysis by multimedia-distraction with an ipad versus anxiolysis by premedication with midazolam prior to the mask-induction of anesthesia. secondly to evaluate the need for midazolam premedication in pediatric day-care surgery patients induced by inhalational anesthesia.

Eligibility criteria:
inclusion criteria * age ≥ 1 year and \<8 years old * asa class 1 or 2 (american society of anesthesiologists physical status classification system) * elective circumcision, tonsillectomy or adenoidectomy, dental care procedure in day-care * written informed consent by the legal parents or caretaker exclusion criteria * parents of the patient wish not to participate with the study * parents are not able to give informed consent (language barrier, legally incapable) * a contraindication for the use of premedication with midazolam * a known allergy to midazolam * a contraindication for premedication in general * a contraindication for the use of a gas-induction/gas-anesthesia * a contraindication for the use of sevoflurane * a known mental retardation of the child * preoperative behavioral disturbances and psychiatric disorders * any use of psychoactive medication * a known photosensitive epilepsy * a previous operation within 3 months of the time of scheduled operation * any other contraindication for the use of the study medication * previous history of multiple surgery (\>3)

Keywords: preanesthetic medication handheld computer midazolam multimedia anxiety mask induction day care surgery