By: 3 August 2016
The effectiveness of screen technology as a distraction tool to alleviate anxiety during induction of anaesthesia

Zoe Ovenden and C Cassar look at the effectiveness of screen technology as a distraction tool to alleviate anxiety during induction of anaesthesia


Induction of anesthesia has been recognized as the most stressful phase of the entire perioperative experience for children.  Poor behavioural compliance with anaesthetic induction because of fear and anxiety can have large detrimental effects post-operatively.  Paediatric anaesthetists employ a range of non-pharmacological methods to distract children to allay anxiety during this time.  Recent studies have shown the benefits of using screen technology in the form of tablets or iPads as useful distraction tools.  Screen technology is not routinely used during anaesthetic induction at the Royal London Hospital.



  1. To evaluate the current use of distraction techniques to allay anxiety during induction of anaesthesia over a 5 day period at The Royal London Hospital.
  2. To measure co-operation of children during induction using our standard distraction techniques.
  3. To implement an intervention week increasing the availability and use of screen technology, and to reaudit the cooperation of children during induction of anaesthesia.


In an observational, prospective study of 171 children aged 2-16 years undergoing general anaesthesia for elective surgery over a two-week period, the type of distraction tool used during induction, the person doing the distraction and the grade of anaesthetist carrying out the induction were all collated.  The cooperation of children with anaesthetic induction was assessed using the Induction Compliance Checklist (ICC) which is a validated observational scale consisting of 10 behaviours scored as the number of behaviours observed during induction; an ICC score >3 is considered poor behavioural compliance; a score of 1-3 is moderate compliance whilst a score of 0 is considered perfect compliance.  The ICC only lists negative behaviours so an extra question was included to allow for any positive behaviours exhibited during the induction process.  The ODA, second anasethetist or play specialist completed a tick box proforma at the end of each induction.  During the first week, only our standard distraction tools were used but during the second “intervention” week, a greater availability and use of screen technology in the form of iPads/tablets were employed.



Talking and conversation as a distraction tool is the most common standard technique employed by paediatric anaestheists at induction of anaesthesia (60.3 per cent), followed by talking in combination with blowing bubbles (25.6 per cent). Currently, tablets alone are used at only 5.1 per cent of inductions.  Using our standard practice we achieved 60.3 per cent perfect compliance at induction and 51.3 per cent of our patients exhibited positive behaviours during the induction process.  During intervention week, the tablets were used in 58 per cent of inductions, most often in combination with talking and 59 per cent of children during that week showed perfect compliance with 70 per cent exhibiting positive behaviours.  When the use of screen technology at induction was evaluated over the whole cohort of patients, the perfect compliance rate was 66.7 per cent and 76.7 per cent of patients showed positive behaviours.



The study has shown that using our standard techniques we are able to achieve a good level of perfect compliance at induction of anaesthesia.  We were able to successfully institute an intervention week and demonstrate that the use of screen technology enhances compliance at induction and greatly improves the patient’s experience.  It is an easy to implement and effective method to reduce anxiety during induction of anaesthesia.



Dr Zoe Ovenden BM FRCA, Specialist Registrar with a special interest in Paediatric Anaesthesia, North East School of Anaesthesia and C Cassar MBBS BSc FANZCA, Consultant Anaesthetist, Royal London Hospital, Barts Health NHS Trust