Active Engagement Game Versus Passive Media During Pediatric Inhalational Induction

Preoperative anxiety is a highly prevalent complication in pediatric anesthesia,occurring in up to 50‐60% of children undergoing surgery. High anxiety during theinduction of anesthesia‐particularly during the application of the face mask‐is stronglycorrelated with poor induction compliance, increased risk of emergence delirium, higherpostoperative analgesic requirements, and long‐term negative behavioral changes.To mitigate these risks, non‐pharmacological behavioral interventions are widelyintegrated into routine pediatric perioperative care. While tablet‐based audiovisualdistraction (e.g., watching cartoons or playing games) has been shown to be a safe andeffective alternative to pharmacological premedication, it is fundamentally limited bythe physical realities of inhalational induction. Specifically, once the anesthesia maskis applied, children lose the physical ability to interact with standard digital games.Consequently, active distraction strategies frequently revert to passive observation atthe exact moment when the child experiences the highest sensory distress.Emerging evidence suggests that active cognitive engagement is superior to passiveobservation for sustained anxiolysis. However, there is a lack of specialized activedistraction tools that safely integrate with the hands‐on airway management workflow ofthe anesthesiologist. To address this gap, the investigators developed a novel, two‐phaseinteractive iPad/phone game. During the awake pre‐induction phase, the child interactsdirectly with the screen. As the anesthesia mask is applied, control of the gameseamlessly transfers to a phone remote operated by the anesthesiologist. Theanesthesiologist synchronizes the remote to the child's spontaneous respiratory rate,providing the child with active, breath‐driven visual feedback on the iPad/phone screenwithout requiring their physical interaction.The primary objective of this pragmatic randomized controlled trial is to determinewhether this breath‐synchronized active engagement game reduces the need for physicalrestraint during pediatric mask induction compared to standard passive media distraction.