Augmented Reality Improves Pediatric Mask Induction: A Prospective, Matched Case-Control Study

Romy Yun; Emily M He; Michelle Zuniga; Nan Guo; Ellen Y Wang; Florence Ho; Molly Pearson; Samuel T Rodriguez; Thomas J Caruso

doi:10.1177/23743735241241146

Augmented Reality Improves Pediatric Mask Induction: A Prospective, Matched Case-Control Study

J Patient Exp. 2024 Mar 28:11:23743735241241146. doi: 10.1177/23743735241241146. eCollection 2024.

Authors

Romy Yun¹, Emily M He², Michelle Zuniga³, Nan Guo¹, Ellen Y Wang¹, Florence Ho⁴, Molly Pearson⁴, Samuel T Rodriguez¹, Thomas J Caruso¹

Affiliations

¹ Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA.
² Stanford University School of Medicine, Stanford, CA, USA.
³ Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
⁴ Department of Child Life and Creative Arts, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.

Abstract

Introduction: Pediatric perioperative anxiety is a significant problem during mask induction for general anesthesia. Immersive technologies, such as extended reality headsets, are a promising strategy for alleviating anxiety. Our primary aim was to investigate mask acceptance during inhalational induction utilizing augmented reality (AR). Methods: This was a prospective, matched case-control study at a quaternary academic hospital. Fifty pediatric patients using AR for mask induction were matched to 150 standard-of-care (SOC) controls. The primary outcome was measured with the Mask Acceptance Scale (MAS). Secondary outcomes of cooperation and emergent delirium (ED) were assessed. Results: MAS scores ≥2 occurred at 4% (95% CI [0, 9.4%]) with AR versus 19.3%, (95% CI [13%, 25.7%]) with SOC (RR 0.21, 95% CI [0.05, 0.84], P = .027). Ninety-eight percent of AR patients were cooperative versus 91.3% with SOC (P = .457). Zero percent had ED with AR versus 0.7% with SOC (P = 1.000). Conclusions: AR during mask induction improved mask acceptance compared to SOC. No relationship was observed between AR and cooperation or ED. Future research will investigate the integration of AR into clinical practice as a nonpharmacologic intervention.

Keywords: anesthesiology; anxiety; anxiety disorders; child; perioperative care; psychometrics.