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Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial
Zeev N Kain1, Alison A Caldwell-Andrews, Linda C Mayes
1Center for the Advancement of Perioperative Health and the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA. zeev.kain@yale.edu
Insights
The ADVANCE family-centered preparation program significantly reduced preoperative anxiety in children and improved postoperative outcomes. This behavioral intervention offers a more effective approach than standard care or sedation for pediatric surgical patients.
Area of Science:
- Pediatric Anesthesiology
- Behavioral Psychology
- Family-Centered Care
Background:
- Preoperative anxiety and distress are common in children and parents undergoing surgery.
- Existing interventions for preoperative anxiety have limited efficacy.
- A novel family-centered behavioral preparation program, ADVANCE, was developed.
Purpose of the Study:
- To evaluate the efficacy of the ADVANCE program in reducing preoperative anxiety.
- To assess the impact of ADVANCE on postoperative outcomes in children.
- To compare ADVANCE with standard care, parental presence, and midazolam sedation.
Main Methods:
- A randomized controlled trial involving 408 children and their parents.
- Four groups: control, parental presence, ADVANCE preparation, and oral midazolam.
- Assessment of preoperative anxiety, analgesic consumption, and emergence delirium.
Main Results:
- The ADVANCE group showed significantly lower anxiety levels preoperatively compared to all other groups.
- Children in the ADVANCE group experienced less emergence delirium and required less analgesia postoperatively.
- ADVANCE preparation led to earlier discharge from the recovery room.
Conclusions:
- The family-centered ADVANCE preoperative preparation program effectively reduces anxiety.
- ADVANCE improves postoperative outcomes in pediatric surgical patients.
- This behavioral approach is a valuable alternative to sedation for managing perioperative stress.
Background:
Children and parents experience significant anxiety and distress during the preoperative period. Currently available interventions are having limited efficacy. Based on an integration of the literature in both the anesthesia and psychological milieus, the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole.
Methods:
Children and their parents (n = 408) were randomly assigned to one of four groups: (1) control: received standard of care; (2) parental presence: received standard parental presence during induction of anesthesia; (3) ADVANCE: received family-centered behavioral preparation; and (4) oral midazolam. The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium.
Results:
Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups (34.4+/-16 vs. 39.7+/-15; P=0.007) and were less anxious during induction of anesthesia as compared with the control and parental presence groups (44.9+/-22 vs. 51.6+/-25 and 53.6+/-25, respectively; P=0.006). Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups (44.9+/-22 vs. 42.9+/-24; P=0.904). Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery (P=0.038), required significantly less analgesia in the recovery room (P=0.016), and were discharged from the recovery room earlier (P=0.04) as compared with children in the three other groups.
Conclusion:
The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes.
