Studies on Anxiety
Preoperative anxiety increases the need for sedative medication.
50% of children experience anxiety regarding an impending surgical experience.
Intense preoperative anxiety can lead to difficulties in anaesthesia induction and increases the need for sedation (Lee et al., 2012).
A high level of anxiety is accompanied by an enhanced pain perception and increased consumption of analgesic medication.
Children who experience high levels of anxiety before anesthesia induction experience more pain during recovery. A comprehensive study investigating 241 children undergoing tonsillectomy and adenoidectomy found that anxious children need more codeine and acetaminophen postoperatively compared with children who were less anxious (Kain, Mayes, Caldwell-Andrews, Karas, & McClain, 2006). Also in adults preoperative anxiety causes a more painful recovery process (Kain, Sevarino, Alexander, Pincus, & Mayes, 2000).
Anxiety is a risk factor for complications and a lengthier stay.
Preoperative anxiety often causes patients to opt for a narcosis rather than a local anesthesia. There, serious complications occur significantly more often than compared to operations under local anesthesia (Memtsoudis et al., 2013).
A higher level of anxiety and pain can delay the postoperative recovery process (Kain, Mayes, Caldwell-Andrews, Karas, & McClain, 2006). Studies show that anxious patients stay in the hospital significantly longer and cause follow-up costs (Kain, 1999; Ruz et al., 2011).
Preoperative anxiety is a risk factor for emergence delirium.
(Dahamani, 2014). Anxious children are eight times more likely to develop delirious states than relaxed children. These can cause a lengthier stay, long-term consequences and further health care costs (Kain, Mayes, Caldwell-Andrews, Karas, & McClain, 2006).
Studies on Audiovisual Distraction
Audiovisual distraction is an inexpensive, easy to administer and comprehensive method to reduce anxiety.
For children, viewing animated cartoons has been shown to be very effective in alleviating preoperative anxiety (Lee et al., 2012). Audiovisual distraction is more effective in reducing anxiety in the preoperative setting than playing with toys (Lee et al., 2012), or traditional distraction methods (Mifflin et al., 2012). Children who experience video distraction are significantly less anxious at induction and show a significantly smaller increase in anxiety from holding to induction than children who are only distracted by nurses (Mifflin et al., 2012). At the dentist, distraction via video glasses leads to anxiety reduction and prevents increase of childrens’ pulse rate (Al-Khotani, Bello, & Christidis, 2016).
Audiovisual distraction during medical procedures alleviates pain in children and adults.
During lithotripsy, distraction by means of videos and music reduces the subjective pain perception and lowers the need for analgesic medication (Marsdin, 2012). Audiovisual glasses successfully lowered pain perception associated with the injection of local anesthesia for dental treatments (El-Sharkawi, El-Housseiny, & Aly, 2012).
Audiovisual distraction can serve as an effective tool for acute pain management.
During painful puncture procedures, audiovisual distraction can significantly decrease the intensity of pain perception in pediatric inpatients (Oliveira, Santos, & Linhares, 2017). Audiovisual interventions are equally effective as psychological interventions for managing pain in children (Wang, Sun, & Chen, 2008).
By means of audiovisual distraction, the dose of sedatives can be reduced.
By providing audiovisual distraction for patients undergoing elective colonoscopy, the requirements of propofol could be reduced significantly (Lee et al., 2004).
Audiovisual distraction can serve as an effective alternative to midazolam.
A comparative study found that audiovisual distraction by means of video glasses reduces preoperative anxiety just as well as midazolam (Kerimoglou, 2013). At time of anesthesia induction, there is no difference in anxiety level when children receive either audiovisual distraction or standard sedation for premedication (Marechal et al., 2017).
Patients receiving preoperative audiovisual distraction recover earlier than patients receiving the standard sedation.
Patients receiving audiovisual distraction can be discharged from the recovery room significantly earlier than patients receiving sedative premedication. This relates to emergence delirium, which occurs less often when patients receive audiovisual distraction in the preoperative setting (Seiden et al., 2014).
Audiovisual distraction can decrease risks, complications and follow-up costs associated with general anesthesia.
More patients choose a local anesthetic process instead of general anesthesia, if a distraction device is offered to them (Willis, 2010).
Video glasses have been used throughout longer operations under epidural anesthesia already and were described as a very useful tool. Hence, by offering an audiovisual distraction device, risks, complications and follow-up costs associated with general anesthesia could be avoided (Athanassoglou, 2015).