Efficacy of Paediatric Preinduction Anxiety Distraction Techniques During Oncologic Procedures

Introduction: Children undergoing oncologic procedures as part of their treatment may suffer from anxiety. It could be related to parental separation, pain/ bodily harm or a previous bad experience of procedure. Pre-procedure anxiety may result in adverse clinical outcomes such as emergence delirium, pulmonary complications and behavioral issues. Preoperative anxiety must be assessed to deal with using appropriate preinduction distraction techniques. Aims & Objectives: The objective of audit is to determine efficacy of preinduction distraction techniques used in our clinical set up (to meet RCoA standards) in reducing anxiety and need of restrain for children at time of induction. Place and duration of study: Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore Pakistan. 14th of January 2020 to 15th of March 2020 (8 Weeks). Material & Methods: It is a prospective outcome-based audit study of 101 children (2-8 years) undergoing intrathecal chemotherapy and bone marrow biopsy at Shaukat Khanum Cancer Hospital, Lahore. All children had non- pharmacological preinduction distraction techniques (Parental/legal guardian presence and/or play car) to reduce anxiety, cry and need for restraint. Anxiety levels as assessed by modified Yale Preoperative Anxiety Scale (mYPAS), cry and restrain were benchmarked with Royal College of Anesthetists (RCoA) standards. Results: A total of 101 children with a median age of 4 years (2-8 years), had 100% parental/legal guardian presence at induction. In our audit, 52% of children cried and 43% were found to be anxious. However, only 21% children required use of restraint (holding still in laps) by accompanying parent/legal guardian. This is acceptable for restraint but not for cry/ anxiety as per RCoA benchmark. Conclusion: Preinduction distraction technique of parental presence and/or toy car, showed only limited benefit in terms of cry, restraint and anxiety levels. Our audited results met benchmark set by RCoA only in terms of restraint but not for anxiety/cry.