Anesthesia System Makes Medical Treatment Less Stressful for Children

Originally Published MDDI October 2002

R&D DIGEST

Providing medical treatment to children, particularly emergency procedures to treat trauma, can be exceptionally difficult. The anxiety children feel in such situations can make them uncooperative, and their typical fear of needles makes administration of painkillers challenging. Most conventional methods for overcoming anxiety and relieving pain in children either fail to address basic fears, or are limited in their effectiveness. Now, a device developed specifically for use with children may mitigate both their pain and their anxiety during treatment.

Developed by Boston-area anesthesiologist Geoffrey A. Hart, MD, and Design Continuum Inc. (West Newton, MA), the PediSedate provides controlled delivery of nitrous oxide and monitors respiration, while keeping the child comforted and entertained. According to Hart, the use of nitrous oxide has significant benefits when treating young patients. "Probably about 25% of emergency centers have access to nitrous oxide, and probably a much larger percentage of dental offices," he says. Hart explains that the gas acts as a mild analgesic and a sedative. Particularly important are its anxiolytic properties—i.e., its ability to decrease a patient's anxiety. Because the use of the gas can be precisely controlled, patients can be discharged more quickly than when other anesthetics are used, he explains.

Hart says a key to developing the device was careful and extensive research into what appeals to children. He and Design Continuum began by testing various prototypes in a children's hospital. After settling on the most successful version, they began looking at what children find most entertaining. "We spent three days at the international toy show in New York," says Hart. "We realized that no one understood what children like . . . more than the toy industry." Hart's research also involved meeting producers of Sesame Street and other television programs and consulting with the MIT Media Lab.

Ultimately, Hart says, the design team realized "that the headset we were developing needed to have some way of entertaining the children." This was particularly important, he says, to help reduce the children's anxiety. The team settled on incorporating Nintendo's Game Boy system into the PediSedate. This allowed them to avoid the time and expense of developing their own interactive program.

The current design also incorporates a transparent system for monitoring respiratory function. To accomplish this, the earpiece of the headset has an integrated ear sensor that allows transcutaneous monitoring of oxygen saturation. In addition, a rotating arm piece attached to the headset has an inflow and an outflow channel. "These lead to the apex of the arm, which contains a mask and scavenging system for volatile anesthetics," says Hart. "The patent for this is held by Porter Instruments, and we have slipped their mask into the design." A capnometer is integrated into the outflow channel to detect the CO₂ concentration in exhaled breaths and provide real-time monitoring of the child's respiratory rate.

The PediSedate is currently undergoing NIH-funded phase II clinical trials at the Floating Hospital for Children at Tufts-New England Medical Center (Boston). Trials are expected to be completed by the end of this year.

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