glasses. Pediatric anesthesiologists, child life specialists, and a
third-party developer at our institution partnered to develop cus-
tomized software and modify hardware to enable the use of AR
technology in pediatric preoperative care (
The Microsoft HoloLens is the first self-contained holographic
computer that enables one to engage with digital content and
interact with holograms. The added ability of providers to mirror
and control the content on a tablet enhances the patient experi-
ence while also allowing personnel to be aware of the child’s
progression through the AR experience. Though other audiovisual
interaction techniques for children exist, AR glasses are unique in
their ability to blend the frightening unfamiliar surroundings of
the hospital with playful and educational holograms. AR glasses
serves as an ideal tool for nonpharmacologic anxiolysis in
patients who fear the completely immersive nature of VR
IRB deemed exempt.
The study was funded by departmental resources.
CONFLICT OF INTEREST
The authors report no conflict of interest.
Thomas J. Caruso
Thomas J. Caruso
Department of Anesthesia, Lucile Packard Children’s Hospital Stanford,
Palo Alto, CA, USA
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adverse events in obese children undergoing elective general surgery.
Br J Anaesth. 2011;106:359-363. Available from: https://doi.org/10.
2. Moadad N, Kozman K, Shahine R, et al. Distraction using the BUZZY
for children during an IV insertion. J Pediatr Nurs. 2016;31:64-72.
Available from: https://doi.org/10.1016/j.pedn.2015.07.010.
3. Lyon J. Augmented reality goes bedside. JAMA. 2017;317:127.
An in vitro analysis of the dead space in 5 supraglottic airway
devices intended for use in small children and infants
Sir—Multiple recent studies have confirmed the efficacy and safety
of different supraglottic devices designed for use in infants and
At this time, there are limited, if any, data on the
dead space of these devices and therefore limited consideration for
the impact of device selection on ventilation in very young infants
Five supraglottic devices, including the LMA-Classic
Sandiego, USA), LMA-Proseal
(Cookgas, St. Louis,
(Intersurgical Ltd, Berkshire, UK), and LMA-Supreme
(Teleflex), were evaluated for dead space. The smallest sizes of each
device were attached via their 9-mm adaptors to a rigid styrene sur-
face using cyanoacrylate adhesive. A bead of silicone sealant was
added around the adapter/styrene interface. An adhesive Tega-
(3M; Health Care, St. Paul, USA) was affixed to the bowl of
the device after filling the attached conduit with a measured amount
of water. A 23-gauge needle was then used to pierce the Tegaderm
and water was injected using a syringe. Air was cautiously vented
through a second hole. The total volume of water needed to fill the
FIGURE 1 A, The holograms Ben and
Jenny mirrored onto a tablet allowing
providers to participate in the experience.
B, The patient happily immersed in the AR
glasses experience, while the IV access
team looks to establish venous access via
the ultrasound [Colour figure can be
viewed at wileyonlinelibrary.com]