Jokes, stories, video clips in operating room can ease kids’ fears of anesthesia

For children who need an operation, the idea of being put to sleep can be one of the most frightening parts of surgery, especially when they see that anesthesia-inducing masked person descending towards their face.

So anesthesiologists, nurses and other surgical staff turn to a veritable wizard’s bag of distraction techniques aimed at reducing anxiety in jittery youngsters, including telling jokes and making up stories.

Recently, staff at IWK Health Centre in Halifax added another way to help kids relax before they are given anesthetic: playing video clips from a favourite TV show or movie, streamed from YouTube and shown on a monitor inside the operating room.

“We have thousands of kids across Canada who have surgery every year, and kids and parents have told us that the most stressful time for them is the time of anesthesia induction,” says Dr. Jill Chorney, a clinical psychologist at IWK.

Children display a range of behaviours, from quiet tears to full-out sobbing, and some even attempt to escape.

“So we’ve been on the hunt for quite a while for ways to help manage kids’ anxiety,” says Chorney, who led a study looking at whether video in the OR might help alleviate kids’ fears even more than standard distraction methods.

Researchers found that children whose attention was focused on a video were significantly less anxious at the time of anesthesia than children in a control group who did not have video in the operating room.

“Probably another way to look at that is we actually found children who had the videotape distraction didn’t show any increase in their anxiety at all, from the time they left the (pre-surgery) holding area to the time that anesthesia was induced,” she says.

“Whereas kids in the control condition showed a significant increase in their anxiety.”

Surgical suites at the hospital were already equipped with video monitors, which were installed for clinical and teaching purposes, “so we were able to pipe in videos through that, which was great,” Chorney says.

While waiting to go into the OR, children are asked to pick from a selection of video clips. Younger kids often opt for “Bob the Builder” or “Dora the Explorer,” while their older counterparts might choose “Hanna Montana” or a Disney movie.

“The clip starts from the moment they (go) into the operating room and plays all the way through until they’re asleep,” she says. “They would become so engaged with the video that the things that were happening around them weren’t nearly as distressing as they would be otherwise.

“And what we know with these kids is the best way to manage distress is to keep them from getting distressed in the first place. It’s much easier to keep a child calm than it is to calm them down if they’re already significantly distressed.”

Indeed, lessening anxiety can help with recovery: studies show that children with high stress at the time of anesthesia administration can experience more post-operative pain and may need to stay in hospital longer than kids who were calmer.

Dr. Conor Mc Donnell, an anesthesiologist at Toronto’s Hospital for Sick Children, endorses the idea of video streaming inside the operating suite, saying “every extra tool in the tool belt is a fabulous addition” for helping kids go through surgery.

“We’ve definitely found in anesthesia that iPads, smartphones, iPhones, video clips and specific apps for cartoons or other characters are very helpful — not for all children all the time, but as an addition to other skills in your armamentarium, such as distraction, humour, funny voices and things like that,” he says.

Anesthesiologists often use their own hand-held electronic devices, which can be safely sterilized for the OR, to provide a young patient with a distracting video or game before putting them to sleep.

“Usually we would get one of the nurses to hold it, if we’re using our hands, while the child watches it,” says Mc Donnell.

Even before surgery, when parents are with their child in the waiting area, Mc Donnell says he gauges how upset his patient is or might become, then begins taking steps to try to calm them.

“One of the things I think is very important is I try to show the child that the parents are comfortable with me. Parents can exhibit as much anxiety as the child and one can feed off the other. I find it’s really important that the child feels that the parents trust you.”

Mc Donnell says he speaks in a soft, gentle voice and avoids coming across as a potentially frightening authority figure.

“I do use a lot of humour,” he says of his own bag of anxiety-reducing tricks. “I do Homer Simpson’s voice. You would be amazed that even two-year-old children seem to love Homer Simpson’s voice.”

A lot of his pediatric patients are enamoured with “Dora the Explorer” and little boys are often into “Star Wars,” he says, adding that there’s “a brilliant Darth Vader you can download into your iPhone.”

Mc Donnell sometimes suggests to young patients intrigued by Darth Vader that they breathe along with the ventilator-dependent character, while he administers anesthetic through a mask.

“It can be a way to distract them and entertain them at the same time.”

Of course, it’s not just anesthesiologists who try to put young patients at ease.

“We have some really, really talented nurses here when it comes to making stories up on the spot,” he says. “They’re just fabulous.”

For young boys who express an interest in “Toy Story,” for instance, he and nurses might use the Buzz Lightyear character as a way to alleviate nervousness when introducing the idea of being put to sleep.

“You start talking about space. And with the mask, it’s like Buzz Lightyear’s space mask, and ‘You might feel yourself floating up like when you get sleepy. So you’re going towards the moon and you see all the stars as you go by,’” he says in a soothing voice.

“It’s just to really try to fold a story into the experience and even prepare them for things that are unexpected,” says Mc Donnell, who continues to relate the story OR staff tell their young charges.

“‘You might feel something a bit strange. Don’t worry, that’s just a spaceship going by very fast.’”