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Parental presence during induction of anesthesia: the surgeon's perspective
Z N Kain1, L A Fernandes, R J Touloukian
1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
Insights
Surgeons' attitudes toward parental presence during anesthesia induction (PPIA) differ significantly between the US and Great Britain. While many US surgeons see benefits, GB surgeons routinely practice PPIA, unlike their US counterparts.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Patient Experience
Background:
- Parental presence during induction of anesthesia (PPIA) is a debated practice in pediatric surgery.
- Surgeons' perspectives on PPIA and its prevalence are not well-documented.
Purpose of the Study:
- To investigate and compare the attitudes and practices of US and Great Britain (GB) surgeons regarding PPIA.
- To assess surgeons' beliefs about the impact of PPIA on child anxiety and cooperation.
Main Methods:
- A questionnaire survey was distributed to members of the Surgical Section of the American Academy of Pediatrics and the British Association of Paediatric Surgeons.
- Data on attitudes toward PPIA and its reported prevalence were collected and analyzed.
Main Results:
- A significant majority of GB surgeons (95%) disagreed that parents should never be present, compared to 60% of US surgeons.
- GB surgeons more frequently believed PPIA decreases child anxiety (92% vs. 69%) and increases cooperation (86% vs. 53%) compared to US surgeons.
- PPIA was reported as routine in >75% of cases by GB surgeons, versus <25% of cases by US surgeons.
Conclusions:
- Significant disparities exist in both attitudes and practice of PPIA between US and GB surgeons.
- Despite acknowledging potential benefits, US surgeons report low routine use of PPIA, contrasting with the widespread practice in GB.
Abstract:
Parental presence during induction of anesthesia (PPIA) remains controversial and little is known about surgeons' attitudes toward this clinical practice. A questionnaire was mailed to all the United States (US) members of the Surgical Section of the American Academy of Pediatrics and all members of the British Association of Paediatric Surgeons. Questions were asked about attitudes toward PPIA in the operating room and the prevalence of such practice. A total of 275 subjects, constituting 72.4% of the compared groups, responded after three mailings. Sixty percent of the US respondents and 95% of the Great Britain (GB) respondents said they disagree with the statement "parents should never be present during induction of anesthesia". Ninety-two percent of the GB respondents and 69% of the US respondents thought PPIA decreases anxiety (p = 0.001) and increases the cooperation of the child (86% GB, versus 53% US, p = 0.001). Most US respondents (72%) reported that PPIA occurs in less than 25% of their cases, but most GB respondents (80%) reported PPIA in more than 75% of their cases (p = 0.001). These differences in prevalence persisted after logistic-regression models were used to adjust for potential confounding demographic variables. We conclude that the attitudes and practice toward PPIA held by surgeons from the US and GB differ significantly. While a large percentage of the US sample agree that there are benefits in PPIA, only a minority report the routine use of PPIA in contrast to most respondents from GB who report PPIA as routine in their hospital.