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Parental presence during induction of anesthesia. A randomized controlled trial
Z N Kain1, L C Mayes, L A Caramico
1Department of Anesthesiology, Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Insights
Parental presence during anesthesia induction did not significantly reduce overall anxiety in children. However, older children, those with less active temperaments, and those with less anxious parents showed reduced anxiety with parental presence.
Area of Science:
- Pediatric Anesthesiology
- Behavioral Intervention Research
- Child Psychology
Background:
- Parental presence during anesthesia induction is a common preoperative intervention.
- Its effectiveness as a behavioral intervention for reducing child anxiety requires rigorous evaluation.
Purpose of the Study:
- To assess the efficacy of parental presence as a preoperative behavioral intervention during anesthesia induction in children undergoing outpatient surgery.
- To identify predictors of children's anxiety response to parental presence.
Main Methods:
- A randomized controlled trial involving 84 children assigned to parent-present or parent-absent groups.
- Assessment of child and parent anxiety using behavioral and physiological measures.
- Multivariate linear regression analysis to examine predictors of response.
Main Results:
- No significant overall differences in behavioral or physiological anxiety measures between parent-present and parent-absent groups.
- Child's serum cortisol concentration indicated parental presence, age, temperament, and parental trait anxiety as predictors.
- Diminished cortisol concentrations with parental presence observed in children older than 4 years, those with low parental trait anxiety, and those with low baseline activity.
Conclusions:
- Parental presence during anesthesia induction benefits specific subgroups of children.
- Beneficial effects were noted in children older than 4 years, those with less anxious parents, and those with lower baseline activity levels.
Background:
To determine whether parental presence during induction of anesthesia is an effective preoperative behavioral intervention, a randomized controlled trial with children undergoing outpatient surgery was conducted.
Methods:
Eighty-four children were randomly assigned to a parent-present or parent-absent group. Using multiple behavioral and physiologic measures of anxiety, the effect of the intervention on the children and their parents was assessed. Predictors for the response to the intervention were examined using multivariate linear regression analysis.
Results:
When the intervention group (parent-present) was compared to the control group (parent-absent), overall there were no significant differences in any of the behavioral or physiologic measures of anxiety tested during induction of anesthesia. Using the child's serum cortisol concentration as the outcome, parental presence, the child's age and baseline temperament, and trait anxiety of the parent, were identified as predictors of the child's anxiety during induction. Analysis of variance demonstrated that three groups showed diminished cortisol concentrations with parental presence: children older than 4 yr (P = 0.001), children whose parent had a low trait anxiety (P = 0.02), and children who had a low baseline level of activity as assessed by temperament (P = 0.05).
Conclusions:
Children who were older than 4 yr or those with a parent with a low trait anxiety or who had a low baseline level of activity/temperament benefited from parental presence during induction.