Anesthesia, Pediatrics
Conditions
Brief summary
Children undergoing surgery and anesthesia are often negatively impacted by anxiety and fear in the preoperative period. Routine inhalational anesthetic induction is a unique aspect of pediatric anesthesia. Inhalation inductions are usually initiated with sevoflurane with or without nitrous oxide. While less pungent than other volatile agents, sevoflurane at high concentrations and flows used for inhalation inductions still causes children to often repel from the smell. This can lead to an unpleasant interaction and cause heightened anxiety for any subsequent procedures. Olfactory senses are processed in the hippocampus and amygdala and tied to emotion and memory. Parosmia is the distortion of smell perception which can utilized to the pediatric anesthesiologists advantage. It has been demonstrated that using this phenomenon, the anesthesiologist can induce a better smell for the child leading to improved cooperation during an inhalation induction. However, limitations of this study include lack of randomization, small sample size, and use of a nominal scale of yes or no for face mask acceptance. The investigators identified no other studies to validate this potentially powerful tool to optimize anesthetic induction for pediatric patients. The overall objective of this pilot randomized trial is to determine the feasibility of parosmia during inhalation inductions to decrease perioperative stress for children and provide key pilot data to power a larger study to determine effectiveness of parosmia during inhalation inductions to decrease perioperative stress for children and provide key pilot data to power a larger study to determine effectiveness of parosmia.
Interventions
OTHERInhalation induction with parosmia
The experimental group will then be told that the patient's favorite smell will be put into the face mask via the magical machine. The patient will be asked to take a deep breath thinking about that smell and then introduce sevoflurane. The patient will be asked if the chosen flavor is smelled and their response will be noted.
Sponsors
Johns Hopkins University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
5 Years to 13 Years
Healthy volunteers
No
Inclusion criteria
* Ages of 5-12 years old * American Society of Anesthesiologist physical status classification system (ASA) I and II * Patients coming from home
Exclusion criteria
* Patients undergoing emergent surgery * Patients who have not adequately maintained preoperative nothing per mouth/os (NPO) status * Patients with inability to communicate verbally * Tracheostomy patients * ASA III , IV, V patients
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative anxiety as assessed by the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) | perioperatively | The modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) will be used to evaluate perioperative anxiety. Patients are evaluated in 4 domains: activity (score 1,2,3, or 4), vocalizations (score 1,2,3,4,5 or 6), emotional expressivity (1,2,3 or 4), and state of apparent arousal (1,2,3, or 4), with higher numbers indicating the highest severity within that item. Each score is calculated by dividing each item rating by the highest possible rating (i.e., 6 for the vocalizations item and 4 for all other items), adding all the produced values, dividing by 5, and multiplying by 100. This calculation produces a score ranging from 23.33 to 100, with higher values indicating higher anxiety. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Type and total dose of opioids administered post-operatively | immediately after the surgery | Type and total dose of opioids administered |
| Length of time (minutes) to post-anesthesia care unit (PACU) discharge | admission to the PACU through discharge from the PACU (<2 hours post-operatively) | Length of time from admission to PACU discharge between the control group and the intervention group |
| Number of antiemetic mediations administered post-operatively | immediately after the surgery | Measuring statistical difference in 1) number of antiemetic medications administered |
Countries
United States
Outcome results
None listed