newsmaker: Anuradha Patel, MD
media coverage: The Star-Ledger, Associated Press, Fox-5 TV, WNBC-TV, National Public Radio (NPR)

Her Very Own Toy Story

by Maryann B. Brinley

Anesthesiologists are the people who work behind the scenes," says Anuradha Patel, MD, a pediatric anesthesiologist at UMDNJ-University Hospital (UH) whose Game Boy research landed her upfront all over the world starting on December 9, 2004, and continuing for weeks afterward.

"You don't usually see much written about us," admits this assistant professor at UMDNJ-New Jersey Medical School (NJMS). Meanwhile, hundreds of news stories, radio interviews and television appearances can't help but make Patel smile. Besides the American coverage, her research results were picked up in France, Spain, by the British, and in the Philippine press, too.

A search on the Internet by her 21-year-old son Anoop, a pre-med student at Yale, prompted him to report, "Mom, you are so popular." Her husband Prem, a surgeon at Brookdale University Hospital in Brooklyn, and her 16-year-old daughter Priya have also been cheering her success. This is a family, as Patel says, where "dinner-time conversations revolve around stories of patients, trauma, and the children I take care of."

When the Game Boy story broke, "it was a little nerve-wracking," she says. "I'm not used to this." Four radio interviews in a row - and impromptu appearances on national television - were enough to rattle anyone. "The Fox-5 producer asked me to come to the studio and I asked, 'Will someone be there to prep me?' I was assured that, of course, it wouldn't be a problem. When I showed up, the news reporter said, 'Oh, good, you're here. You're on in five minutes and it's live."

"Live?" Patel asked.

"Yes," she was told, "live," with no rehearsal.

"But I think I did okay."

Composed and articulate, Anu Patel, winner of a NJMS 2004 Golden Apple Award for teaching, could never have guessed that her 25-year clinical career would take such a newsworthy turn when she began researching ways to reduce children's anxiety before surgery and zeroed in on Game Boys, the hand-held electronic toys created by Nintendo. "This was my first venture into research and what a surprise it has been. I love children and I love working in Newark. It's unbelievable how much good you can find in children."

During her medical school years and initial training back in India at Government Medical College University of Jabalpur, she had considered going into ophthalmology. "One day when I was in the operating room, there was an emergency. Something had gone wrong and at that point during surgery, the person who was totally in charge, telling everyone in the OR what to do, was the anesthesiologist. That's when I decided to pursue anesthesia."

After coming to America, Patel continued her medical education at Albert Einstein Medical College in Philadelphia, where she was encouraged to focus on pediatric anesthesiology. "There is always a shortage of pediatric anesthesiologists." She's been at UH and NJMS for six years. While UH does not specialize in children, pediatric procedures have been growing steadily and the hospital does from 1,300 to 1,400 a year.

Anesthetizing children takes highly specialized training. Immature circulatory and respiratory systems are not the same as in adults. Kids "even have more body water," which can affect dosages, Patel explains. "They do not metabolize drugs as fast as adults and may need more medicine, not less."

One aspect of anesthesia that may be the same for many adults and children alike, however, is the fear factor. "I've had people say to me, 'Doc, I know the surgery will be okay but will I come out of the anesthesia?' This anxiety before surgery is very real and anesthesiologists are always looking for ways to reduce the stress." For children, pre-operative waiting rooms sometimes provide video games, toys, music headsets, and books. Having a parent present will supposedly help kids relax as well as anti-anxiety drugs like midazolam. "But the medicine tastes bitter and children don't like taking it," Patel says. In addition, some parents don't want children taking sedatives that can outlast the effects of the anesthesia.

After observing the rapt concentration of the 7-year-old son of a friend while he was playing with a Game Boy, Patel had a brainstorm. "A lot of ideas come to me and I just jot them down," she explains, pointing to a list of future research projects up on her bulletin board. "This little boy's concentration had shut out the world. He actually forgot where he was." She theorized that giving children Game Boys before and even during the trip into the operating room would reduce their stress levels. Because the UH anesthesiology department, under chief Ellise Delphin, MD, has made research a higher priority for clinicians in the past year, Patel found it easier to test her hypothesis. A research nurse for anesthesiology, Catherine Schoenberg, RN, and Henry Bennett, PhD, Director of Research, became invaluable to Patel.

With the help of fellow UH anesthesiologists Melissa Davidson, MD, and Thomas Schieble, MD, but especially anesthesiology nurse Sue Walsh's son Christopher, Patel's randomized, controlled study began in February 2004 and continued until October. It was Christopher who collected 30 used Game Boys and 60 games as part of his requirements for an Eagle Scout project. "Chris did such a good job fixing all the old Game Boys so they would work. He carefully labeled and organized the games, too." A file drawer filled with these colorful electronic gadgets corroborates Chris' hard work. Unfortunately, "We don't have enough to let the kids take them home," she says.

Game Boys Wanted Donate a new or used Game Boy to the Anesthesiology Department at University Hospital. Send it to the attention of Catherine Schoenberg, RN, UMDNJ- University Hospital, 150 Bergen Street, Room F-102, Newark, NJ 07107-1709.

Patel's study enrolled 78 children between ages 4 and 12. After using an anxiety scale to quantify each child's stress level, the researchers assigned children to one of three groups: the first had parents to calm them; the second group received the medication; and, in the third group, children were offered Game Boys about 30 minutes before scheduled anesthesia. Children in the Game Boy group loved the activity so much they would be engrossed all the way onto the operating room table. Patel reports, "They would say, 'Wait, wait. I can't go to sleep yet. I need one more minute to finish the game.' "

When the research results were tallied using a modified Yale Pre-Operative Anxiety Scale, the hand-held video games proved to be more effective in treating severe anxiety than medication and far better as a calming factor than parents' presence. Using their hands and their heads produced a cognitive effect. Patel is currently preparing the work for publication and moving forward with a plan to conduct post-operative Game Boy research as well. She wonders: if children go under anesthesia calmly and come out just as relaxed, will they go home and have fewer nightmares or less emotional fallout from their hospital experience?

In the meantime, she's happy to have changed a stereotype about video games, toys that are often blamed for creating violence in children. "We found something good in them."

Her research also supports a deep-seated sense about her specialty. "People always say that anesthesiologists have such a short exposure to patients. This may be true but, to me, if I can change their stress level and make them comfortable, I can have a long lasting impact." Her toy story may even have a long lasting effect on Patel herself. Of course, she's now that doctor with the Game Boys. "I watch children come in and see how anxious they are. I've always tried to be friendly but now I hand them a toy and I can see them thinking, 'Hey, how bad can this be if she's giving me a Game Boy to play?' "