video glasses
When video glasses are used compared to oral midazolam premedication, anxiety is less when a child is being transported to the operating room. (Image source: Thinkstock)

Anxiety before a surgical procedure is to be expected.  As anesthesiologists, we tend to be more focused on pharmacologic therapy.  However, behavioral approaches, specifically distraction, can also be used to decrease stress.

Video glasses have been around since the mid-1990s, Early users appeared to have large binoculars strapped to their heads. Newer models are both lighter and cheaper.  Dr. Beklen Kerimoglu, Department of Anesthesiology, SUNY Downstate Medical Center, Brooklyn, NY and colleagues examined anxiety before surgery in 96 children aged 4 to 9 years who used video glasses, received midazolam, or were given both.  Their work is published in this month’s issue of Anesthesia & Analgesia in the study “Anesthesia Induction Using Video Glasses as a Distraction Tool for the Management of Preoperative Anxiety in Children.”

Children undergoing ambulatory surgery were randomized to receive midazolam 0.3 mg/kg, video glasses (Vuzix®, Vuzix Corporation, Rochester, NY) connected to a portable media player, or both midazolam and video glasses.  Anxiety was measured using the modified Yale Preoperative Anxiety Scale before the intervention, during transport to the operating room, and then during anesthesia induction.

Children were anxious before the intervention and during anesthesia induction. There was no difference in anxiety between the three study groups at these two times.  However, during transport to the operating room, anxiety was lowest in the group given just video glasses.   The increase in anxiety from baseline to induction was significant for children who received midazolam, with or without video glasses, but not for children who only wore the video glasses.

Though there was no statistically significant difference between the three groups during anesthesia induction, but children wearing video glasses tended to have less anxiety. It is unclear whether or not the difference would have been significant if the study was larger.

The authors did not measure outcome during recovery. Would recovery times have been less with use of the video glasses?  Would parental presence have a different effect on outcome?

As the authors also noted, the media that came with the glasses was limited. Might the effect of the video glasses have been stronger if the child was allowed to bring their favorite video from home?

This study can be considered an interesting pilot study. Hopefully it will be followed by a larger trial to assess the utility of video glasses combined with a child’s favorite media to manage preoperative anxiety in children.