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Is there a place for parents in the operating room?
M W Gauderer1, J L Lorig, D W Eastwood
1Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH.
Insights
Parental presence in the operating room during anesthesia induction is safe and effective for pediatric patients. This practice reduces child anxiety and parental stress, proving beneficial in ambulatory surgical centers.
Area of Science:
- Pediatric Anesthesiology
- Ambulatory Surgery
- Child Psychology
Background:
- Parental presence during pediatric anesthesia induction is a debated practice.
- Concerns include OR disruption and parental anxiety.
- Previous studies have yielded mixed results regarding feasibility and safety.
Purpose of the Study:
- To evaluate the feasibility, safety, and acceptance of parental presence during anesthesia induction in a pediatric ambulatory surgical center.
- To assess the impact on patient outcomes and OR workflow.
- To gather feedback from parents and surgical staff.
Main Methods:
- A retrospective review of 3,086 pediatric patients (<15 years) over nearly 4 years.
- Data collected on patient demographics, surgical services, and outcomes.
- Parents accompanied children during anesthetic gas induction without premedication.
Main Results:
- High acceptance rate among parents; nearly all chose to be present.
- Only five patients required hospital admission post-procedure.
- Minimal disruption to OR routine due to thorough preoperative parental preparation.
- Excellent parent feedback and staff enthusiasm reported.
Conclusions:
- Parental presence during pediatric anesthesia induction is safe, simple, and effective in ambulatory settings.
- The practice leads to decreased psychological trauma for children and reduced parental anxiety.
- Careful preoperative preparation mitigates potential disadvantages, making it a valuable option.
Abstract:
The presence of a parent in the operating room (OR) during induction of anesthesia is controversial. In order to assess the feasibility, safety, and acceptance of this practice, we evaluated a near-4-year experience with 3,086 patients less than 15 years of age, who were operated on at a free-standing ambulatory surgical center. The age distribution was: 1 to 23 months, 790; 2 to 5 years, 1,190; 6 to 10 years, 775; and 10 to 15 years, 331. The distribution of patients by service was: otorhinolaryngology, 1,597; pediatric surgery, pediatric urology, and plastic surgery, 948; ophthalmology, 443; orthopaedics, 72; and dental, 26. No premedication was employed. Anesthetic gases were delivered via a mask while the parent held or remained close to the child. Vascular access was established after the induction. Only five patients (tonsillectomy, four; circumcision, one) were admitted to the base hospital and subsequently discharged. Advantages of parental presence in the OR during anesthesia induction are decreased psychological trauma (child), smoother induction (child), and decreased parental anxiety. Possible disadvantages include disruption of OR routine, unpredictability of parental behavior, and increased time and cost. Because of careful preoperative preparation of parents by the nurses and anesthetists, the first three problems rarely occurred. The cost of supplies used by each parent was minimal. Practically all parents chose to accompany the child to the OR. The feedback during follow-up from those parents has been excellent. Nurses, anesthesiologists, and surgeons are enthusiastic about the program. In the examined setting, this approach has proven safe, simple, and effective.