iPhone to induce anesthesia
This afternoon I am wheeling a patient out of the operating room to recovery. During this routine bone marrow aspiration, my attending was sitting at a computer catching up with some of the latest journal articles. Knowing that I am an Apple guy, he prints out for me the following article:
My wife and I will be switching to AT&T as well as iPhone, after the 2.0 release this summer. Already my attending is talking about replicating the conditions of this correspondence in the form of a randomized controlled trial. I wonder if there is a way to get Apple to sponsor such an endeavor... or better, Microsoft or Samsung to avoid any claims of bias?
My wife and I will be switching to AT&T as well as iPhone, after the 2.0 release this summer. Already my attending is talking about replicating the conditions of this correspondence in the form of a randomized controlled trial. I wonder if there is a way to get Apple to sponsor such an endeavor... or better, Microsoft or Samsung to avoid any claims of bias?
Comments
No IRB approval? No control group? Using children for research without informed consent?
I'm not sure if your response was meant to be sarcastic. On the assumption that it is not, I will reply.
As physicians, we are trained to be absolutely respectful of the patient's right to self-determination, or in the case of minors, the parents' rights to determine the course of treatment for their child. I was not suggesting that unsanctioned experiments be carried out, or that the writers of this letter did do so. Sorry if I sound defensive, but given the shameful past history of medicine in respecting the above mentioned rights, its something to which I am particularly attuned.
I'd like to point out that this article was "correspondence" rather than "a study", and as such, only highlights areas that may warrant further research done under controlled circumstances. This is often how scientific and medical inquiry starts. A novel observation is reported, scrutinized and then made the subject of approved controlled experimentation.
Relieving anxiety in a child who is about to be anesthetized is the subject of folklore and personal ritual more than it is about any science. While I might keep my face uncovered and hum whilst holding a bubble-gum scented mask to their face, others might pick up the kid, throw them over their shoulder and do the "airplane" thing down the hallway towards the OR. In adults, it has been well demonstrated that a good pre-operative conversation with the anesthesiologist is better at relieving anxiety than medications. Children are not reasonable in the same way adults are, but they are highly distractible.
Letting a kiddo play with an iphone and letting him or her watch it as they go to sleep may very be one of the easiest and most benign form of anxiolysis that I can imagine. If it can spare them undue stress or excessive pharmacology, would this not be worthwhile to pursue?
I didn't really think it was that big a deal originally. I brought the iphone on release day in Seattle, uploaded some movies I had onto it. The next day my (own) kids were watching movies on my iphone, I couldn't get them off it. I thought maybe this would be useful at work... So just started doing it. The nurses loved it, the kids got taken off their parents with no versed onboard - often they were giggling during the induction. The parents loved the fact it was one less drug, and that their kid was quite happy to jump up into someone's arms to get carried to the OR without tears. The postop nurses loved the way they got through recovery quicker and were able to discharge quicker (all anecdotal of course).
King 5 TV news got quite interested and came to film the iphone induction a few weeks back - it hasn't aired yet... I'll post when it does.
I called Apple to try and get some iphones for the department, but have had no response.
I toyed with the idea of a randomised controlled trial... but to be honest its just a tool. Although I've reduced my premedication rate by over 90% at the time of writing this - there is still the kid every now and again who just won't engage... who still gets premedicated. I don't see the point in a randomised control trial - I know what I can do with the iphone and what I can't!
I'm returning to my home in the UK tomorrow - and keen to continue using my iphone there to the same effect... So Apple if you are reading this - I need a UK iphone ASAP! Or a way to unlock my US iphone to use in the UK...
http://www.king5.com/video/index.html?nvid=239573&shu=1