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King Fahad National Guard Hospital; Riyadh, Saudi Arabia; Gehan55555{at}hotmail.com
To the Editor:
Inhaled induction of anesthesia is a commonly used method by pediatric anesthesiologists. Sevoflurane induction is smooth and rapid; however, children tend to resist the application of the mask on their face. Exaggerated preoperative child’s anxiety has been reported to result in adverse behavioral outcomes that can be extended up to 2 weeks postoperatively (1,2). Several methods have been introduced to overcome this problem. Parental presence during induction, special operating room environment, premedications, and using specific induction techniques helped to decrease preoperative child’s anxiety. I report a new method to help the children accept the anesthetic face mask and to obtain nonturbulent induction.
I have designed a three dimensional mask of common characters that are popular among children, for example, animals, birds, and famous cartoon characters. The mask is made of colored thin foam sheets with two big openings for the eyes and the space for the nose and mouth is left for the connection with the anesthetic mask at the inflation port of its air cushion through a small opening in the middle of the lower part of the character mask. The mask is attached to the child’s ears by two rubber bands or one rubber band attached near the ears and fixed behind the head. The child is then given a mirror to look at his funny face (Fig. 1). When we ask him to blow up the balloon, it will be like a game.
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After obtaining our local Ethics Committee’s approval and parents’ consent, 56 children aged 2–10 years undergoing routine outpatient surgery were offered to choose the character mask they like. The attending anesthesiologist connected the suitable sized anesthetic face mask to the character mask, and the assembled new mask was applied to the child’s face. We observed whether the child accepted or refused the mask. A parent was allowed to attend the induction phase. In the operating room, the anesthetic circuit was primed with 8% sevoflurane in oxygen/nitrous (1:1) and attached to the anesthetic face mask that is already fit to the child’s face. When the child lost consciousness, the character mask was removed and anesthetic induction was continued as planned. The parent was asked about his or her impression of the anesthetic induction, and their response was graded as indifferent, good, and excellent.
Forty-nine children (87.5%) accepted the mask and 7 of 56 (12.5%) refused the application of the mask. Of the 49 patients who accepted the mask, parents’ impression was as follows: 42 excellent, 5 good, and 2 indifferent.
We think this new mask is a new successful tool that can be added to the arsenal of methods used to make inhaled induction more acceptable by children.
References
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