Distraction

To kids, going to the hospital is right up there with going to the dentist. When they arrive in our pre-operative area, they are scared, anxious, crying, inconsolable. How do we as anesthesiologists convince them to come with us to a terrifying, cold operating room, allow us to put a mask on them, or get close to them with a needle? Part of pediatric anesthesia is learning the developmental stages of children, their coping mechanisms, and how to negotiate with them. They are certainly not "little adults." Calm rationality works only with a minority of children and teenagers. For the rest, we cajole, trick, distract, and amuse.

For some, we create stories. The mask becomes an astronaut mask, the bed a space shuttle, the surgical lamps satellites. For others, we challenge. The blood pressure cuff measures muscles, the balloon on the breathing circuit tests a swimmer's lung capacity. I like bantering with the kids; asking them about when school starts or their next birthday party or their siblings takes their attention from the frightening machines that line the hallways. We flavor the masks with watermelon, strawberry, caramel, or wintergreen scents (no one has asked for the last one yet, but one can hope). We give them masks for their dolls, stickers for their stuffed animals. Children span a huge emotional range; some have been through this many times and know exactly what to expect; some shed their apprehension when we bring in our toys; some refuse to trust us no matter what we do. It's playing and it's fun, but we are also keenly aware that we have to balance the child's well-being, the parent's anxieties, the surgeon's desire to get started, and the efficiency of the operating room day. Overall, though, it's a pretty fun job.