124 Chapter 2 Paper Country Target group N % male Age, mean (SD) Age range Intervention arms Intervention characteristics Assessments Variables measured Findings relevant for current review Sakizci Uyar et al. 2021 Turkey Children undergoing ambulatory surgery 138*h 44.0 6.60 (1.03) 5-8 years 1. Premedication with midazolam (standard care). 2. Watching an informative cartoon about anaesthesia. 3. Playing video games of their choice (game distraction). Participants received the intervention in the pre-operative holding area. Twenty minutes after the intervention, they were transported to the operation room. Participants in the video game group were allowed to play until loss of consciousness. Before and 20 minutes after the intervention (both pre-operatively), while entering the operating room, and during mask induction. Anxiety, cooperation during mask induction. From before to after the intervention, the video game group showed a reduction in anxiety compared to with the midazolam and cartoon group. After the intervention and while entering the operating room, the game group showed less anxiety than the cartoon group. At mask induction there were no differences between the groups. Schlechter et al. 2021 USA Children and adolescents who required IV placement as part of their emergency department care 116*i 47.8 11.00 (4.19) 4-17 years 1. Virtual reality game distraction. 2. Standard of care, including the provision of standard distraction techniques such as reading a book or iPad use. 1. Participants played the VR game while venipuncture was performed, for as long as it takes to place the IV. 2. Venipuncture was performed per standard of care. Pre and post IV placement. Success on first attempt of IV placement, anxiety, number of IV attempts, median time to successful IV placement, change in pain level, removal of the VR headset, adverse events. Changes in anxiety scores were similar between the groups. Stewart et al. 2019 USA Children undergoing outpatient surgery 102 57.8 6.85 (2.44) 4-12 years 1. Tablet-based interactive distraction (game distraction). 2. Oral midazolam control group (standard care). 1. Participants started playing one minute before parental separation and continued playing through mask induction. 2. Midazolam was given 15 to 45 minutes before separation. Baseline, at parental separation, at mask induction, and 7 and 14 days postoperatively (behavioural changes only). Anxiety, emergence delirium, caregiver satisfaction at the time of separation, length of stay in post anaesthesia care unit (PACU), postoperative behavioural changes. Participants in the intervention group were less anxious at parental separation and mask induction than children in the control group, and demonstrated lower emergence delirium and were discharged earlier. Notes. Intervention arms and variables measured in bold are included in the forest plot. All studies used a regular randomised controlled trial (RCT) design. FU = follow-up; IV = intravenous; NA = not available and/or could not be obtained; PTSS = post-traumatic stress symptoms; VR = virtual reality.
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