Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial

Afsaneh Sadeghi, Ahmad Khaleghnejad Tabari, Alireza Mahdavi, Sara Salarian, Seyed Sajjad Razavi, Afsaneh Sadeghi, Ahmad Khaleghnejad Tabari, Alireza Mahdavi, Sara Salarian, Seyed Sajjad Razavi

Abstract

Introduction: Anesthesia induction is a stressful event for children and their parents, and may have potentially harmful consequences on the patient's physiological and mental situation. Stressful anesthesia induction has psychological adverse effects that recur with repeated anesthesia, can lead to increased pediatric discomfort during the recovery period, and may even induce reactionary postoperative behavior. A randomized controlled trial was performed to assess the impact of parental presence during induction of anesthesia (PPIA) on preoperative anxiety of pediatric patients and their parents at three different times, cooperation of child with anesthesiologist at induction of anesthesia, and parental satisfaction.

Patients and methods: A total of 96 pediatric patients undergoing elective minor surgery (ASA 1-2) were randomly divided into two groups. Both groups received oral midazolam (0.5 mg/kg) at least 20 minutes before surgery, but in the PPIA group, the parents were also present in the operating room until loss of consciousness of child at anesthesia induction. Anxiety in the patients (as measured by the modified Yale Preoperative Anxiety Scale [mYPAS]) and parents (as measured by the State and Trait Anxiety Inventory [STAI]), the Induction Compliance Checklist (ICC), and parental satisfaction (as measured by visual analog scale) were assessed.

Results: There was no significant difference in the mean anxiety scores (mYPAS) of participants in the control and PPIA groups at ward T0 and upon arrival to operating room T1 (P>0.05). However, between the PPIA and control groups, mean mYPAS score was different at the time of induction of anesthesia T2 (35.5±16.6 vs 59.8±22.4; P<0.001). The ICC scores showed that perfect score was significantly different in the PPIA and control groups (66.6% vs 6.3%; P<0.01). The STAI scores of the parents in the two groups did not differ in T0, T1, and T2. The mean parental satisfaction score was higher in the PPIA group than in the control group (7.6±7.0 vs 5.8±6.1; P<0.01).

Conclusion: PPIA may reduce preoperative state anxiety of pediatric patients and improve quality of anesthesia induction based on ICC scores and higher parental satisfaction, but it does not impact on parental state anxiety.

Keywords: anesthesia induction; anxiety; children; parents.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Chorney JM, Kain ZN. Behavioral analysis of children’s response to induction of anesthesia. Anesth Analg. 2009;109(5):1434–1440.
    1. Rice M, Glasper A, Keeton D, Spargo P. The effect of a preoperative education programme on perioperative anxiety in children: an observational study. Paediatr Anaesth. 2008;18(5):426–430.
    1. Beaupre LA, Lier D, Davies DM, Johnston DB. The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol. 2004;31(6):1166–1173.
    1. Caprilli S, Messeri A, Busoni P. Preoperatory anxiety in children: psychological evaluation of premedication and parental presence efficacy. Pediatr Med Chir. 2004;26(3):169–174.
    1. Mc Ewen AW, Caldicott LD, Barker I. Parents in anesthetic room – parents’ and anesthetists’ views. Anaesthesia. 1994;49(11):987–990.
    1. Kain ZN, Mayes LC, Wang SM, Caramico LA, Krivutza DM, Hofstadter MB. Parental presence and a sedative premedicant for children undergoing surgery: a hierarchical study. Anesthesiology. 2000;92(4):939–946.
    1. Palermo TM, Tripi PA, Burgess E. Parental presence during anaesthesia induction for outpatient surgery of the infant. Paediatr Anaesth. 2000;10(5):487–491.
    1. Arai YC, Ito H, Kandatsu N, Kurokawa S, Kinugasa S, Komatsu T. Parental presence during induction enhances the effect of oral midazo-lam on emergence behavior of children undergoing general anesthesia. Acta Anaesthesiol Scand. 2007;51(7):858–861.
    1. Yip P, Middleton P, Cyna AM, Carlyle AV. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev. 2009;(3):CD006447.
    1. Berghmans J, Weber F, van Akoleyen C, et al. Audiovisual aid viewing immediately before pediatric induction moderates the accompanying parents’ anxiety. Paediatr Anaesth. 2012;22(4):386–392.
    1. Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstadter MB. The Yale Preoperative Anxiety Scale: how does it compare with a “gold standard”? Anesth Analg. 1997;85(4):783–788.
    1. Speliberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the state – Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press; 1983.
    1. Kain ZN, Mayes LC, shu-Ming Wang, Caramico LA, Hofstadter MB. Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective? Anesthesiology. 1998;89(5):1147–1156.
    1. Astuto M, Rosano G, Rizzo G, Disma N, Raciti L, Sciuto O. Preoperative parental information and parents’ presence at induction of anaesthesia. Minerva Anesthesiol. 2006;72(6):461–465.
    1. Cameron JA, Bond MJ, Pointer SC. Reducing the anxiety of children undergoing surgery: parental presence during anaesthetic induction. J Paediatr Child Health. 1996;32(1):51–56.
    1. Lui JC, Wu KK. Parental anxiety associated with participation in anaesthetic induction in children: questionnaire survey. Hong Kong Med J. 1999;5(1):21–26.
    1. Kain ZN, Caldwell-Andrews AA, Maranets I, Nelson W, Mayes LC. Predicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach. Anesth Analg. 2006;102(1):81–84.
    1. Varughese AM, Nick TG, Gunter J, Wang Y, Kurth CD. Factors predictive of poor behavioral compliance during inhaled induction in children. Anesth Analg. 2008;107(2):413–421.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe