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30 t m c » p u l s e | s e p t e m b e r 2 0 1 9 Distracting Kids Before Surgery Video and virtual reality help young patients in pre-op and during initial stages of anesthesia B y A l e x a n d r a B e c k e r induction in the operating room. Patients like Charlie Pennell speak into an anesthesia mask while a member of the anesthesia care team controls the reactions of cartoon characters. An especially popular game involves a dragon named Sevo, who breathes fire on his food in order to cook it. As the patient breathes into the mask, Sevo breathes fire, eventually cooking his meal enough to gobble it down. Most patients, however, are peacefully asleep by then. "Our notorious patient groups are 2- and 3-year-olds—they're happy to see you out in the holding area, but then they want nothing to do with you when it's time to separate from their parents," Fuller said. "I played the Sevo game a few days ago with a 3-year-old, and she smoothly went to sleep, and, when she woke up, all she would talk about was her dragon. She talked about it the whole time and requested to play it again in the recovery unit. So, her whole perception of her visit here, the only thing she would talk about, was C harlie Pennell grew drowsy as he watched a pair of cartoon aliens projected onto the wall. The 10-year-old, who held an anesthesia mask to his face, was happy and relaxed. The characters asked him to call out their names, and with each breath, the nitrous oxide slowly took effect as he fell asleep on the operating table. This non-traditional practice is part of a new program at Texas Children's Hospital aimed at calming pediatric patients ahead of surgery. Known as the CHARIOT program—Childhood Anxiety Reduction through Innovation and Technology—the suite of entertainment options uses video and virtual reality to engage patients in the pre-operative setting and during the initial stages of anesthesia. "The use of our various technologies has made it easier to focus our patients' attention away from an experience that is new and different and possi- bly frightening to them and onto something that they're much more comfortable with—and it helps them work through this experience to get surgical Four-year-old Asher Temple watches the movie "Minions" before surgery at Texas Children's Hospital. procedures that they very much need," said Clint Fuller, M.D., a pediatric anesthesiologist at Texas Children's Hospital. "It's made it a much easier process both for them and for us." The technology suite includes different options based on patient preference and matu- rity. For younger kids, a projector called BERT (Bedside Entertainment Relaxation Theater) can play a selection of popular movies, including "Moana," "Coco," "Finding Dory," "Cars" and "Minions." "If there's a long wait-time and the patient starts to get anxious during the wait, it's a nice way to really distract them so their minds are not on the actual surgery or the fact that they're hungry from fasting," explained pediatric anes- thesiologist Kathleen Chen, M.D., who leads the CHARIOT program at Texas Children's. "I usually tell them that today is your day, and whatever you want, we can give that to you." BERT also projects interactive games, which are especially helpful for inhalation anesthesia