The Impact of Scripted Self-Hypnotic Relaxation on the Periprocedural Experience and Anesthesiologist Sedation Use in the Pediatric Cardiac Catheterization Suite: A Prospective Randomized Controlled Trial

Abstract

Jacqueline Viegas,1 Helen Holtby,2 Kyle Runeckles,3 Elvira V Lang4 1Cardiac Diagnostic and Interventional Unit, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; 2Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada; 3University Health Network Research Institute, Toronto, Ontario, Canada; 4Hypnalgesics, LLC, Brookline, MA, USACorrespondence: Jacqueline Viegas, Cardiac Diagnostic and Interventional Unit, Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G1X8, Canada, Tel [phone], Fax [phone], Email [email protected]: To assess the impact on children of self-hypnotic relaxation scripts read by trained staff prior to the induction of anesthesia and/or extubation on the periprocedural experience.Patients and Methods: A total of 160 children aged 7– 18 years undergoing a cardiac catheterization intervention under general anesthesia were randomized into 4 groups: (1) a pre-procedure (PP-script) read prior to entering the procedural room, (2) a script read prior to extubation (PX-Script), (3) both PP- and PX-Scripts read and (4) no script read. Anxiety and pain were rated on self-reported 0– 10 scales. The modified Yale Preoperative Anxiety Scale was used for preoperative anxiety. The effect of script reading was associated with outcomes by linear regression for continuous variables, and logistic regression for binary variables in two-sided tests at a significance level of 0.05. Results are given in odds ratios (OR) and 95% confidence intervals (CI).Results: Data were available for 158 patients. Reading the PP-Script prior to anesthesia was associated with a significant reduction in the use of intraoperative sedatives from 30% to 14% (OR 0.40; CI 0.18– 0.88; p = 0.02) by the anesthesiologists, who were blinded to group attribution until extubation. This was despite the children not self-reporting significantly lower levels of anxiety or pain. The PX-Script did not change outcomes. Among groups, there was no significant difference in room time, postoperative recovery time and pain.Conclusion: Reading a PP-Script for guidance in self-hypnotic relaxation can result in less need for intravenous sedation in the judgment of the anesthesiologist, independent of the children’s self-reported anxiety and pain. This raises interesting questions about subconscious patient–physician interactions affecting pain management.Clinicaltrials.gov Identifier: NCT02347748.Keywords: sedation, anesthesia, children, pain, anxiety

Keywords

• sedation -– anesthesia - children – pain – anxiety