A sequential examination of parent-child interactions at anesthetic induction

Parents’ Time Perspective as a Predictor of Child’s Postsurgical Pain, Emergence Delirium, and Parents’ Posttraumatic Stress Disorder Symptoms after Child’s Surgery

Background: The aim of this study was to predict children’s postsurgical pain, emergence delirium and parents’ posttraumatic stress disorder symptoms after a child’s surgery based on the parents’ time perspective. Method: A total of 98 children, aged 2 to 15, and their accompanying parents participated in this study. Measures of parents’ time perspective and posttraumatic stress disorder symptoms were obtained based on questionnaires. The level of children’s postsurgical pain and delirium were rated by nurses and anaesthesiologist. Results: Parents’ future-negative perspective was a predictor of emergence delirium in the group of children aged 8–15 years. Low parents’ past-positive perspective turned out to be a predictor of parents’ posttraumatic stress disorder symptoms after child’s surgery. Conclusions: The results provide evidence for associations between parents’ time perspective with child’s emergence delirium and parents’ posttraumatic stress disorder symptoms after child’s surgery.

Pilot Examination of the Efficacy of the Internet-Delivered, Preoperative, Preparation Program (I-PPP)

Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to compare the Internet-delivered, preoperative program (I-PPP) in alleviating anxiety in children undergoing outpatient surgery delivered alone (I-PPP) and in conjunction with parental presence (I-PPP + parent) to treatment as usual (TAU). 104 children undergoing day surgery procedures at a local hospital and their parents/guardians participated. Primary outcome measures: (a) observer-rated child anxiety and (b) induction compliance. Results demonstrated an interaction between the I-PPP and TAU groups over time, F(1, 64) = 5.11, p = .027, partial η _p ²  = .07. At anesthetic induction, the I-PPP group demonstrated lower observer-rated anxiety than TAU, F(1, 64) = 4.72, p = .034, η _p ²  = .07. I-PPP group demonstrated the best anesthesia induction compliance, F(1, 64) = 4.84, p = .031, η _p ²  = .07. Our findings demonstrate that the I-PPP is an efficacious preoperative preparation intervention for children. The 'real-world' uptake and integration of the I-PPP into pediatric preoperative settings require exploration going forward. Trial retrospectively registered March 2019 (Open Science Registration https://doi.org/10.17605/osf.io/2x8rg ).

Anaesthesia for the paediatric outpatient

PURPOSE OF REVIEW

The aim of this review was to discuss recent developments in paediatric anaesthesia, which are particularly relevant to the practitioner involved in paediatric outpatient anaesthesia.

RECENT FINDINGS

The use of a pharmacological premedication is still a matter of debate. Several publications are focussing on nasal dexmedetomidine; however, its exact place has not yet been defined. Both inhalational and intravenous anaesthesia techniques still have their advocates; for diagnostic imaging, however, propofol is emerging as the agent of choice. The disappearance of codeine has left a breach for an oral opioid and has probably worsened postoperative analgesia following tonsillectomy. In recent years, a large body of evidence for the prevention of postoperative agitation has appeared. Alpha-2-agonists as well as the transition to propofol play an important role. There is now some consensus that for reasons of practicability prophylactic antiemetics should be administered to all and not only to selected high-risk patients.

SUMMARY

Perfect organization of the whole process is a prerequisite for successful paediatric outpatient anaesthesia. In addition, the skilled practitioner is able to provide a smooth anaesthetic, minimizing complications, and, finally, he has a clear concept for avoiding postoperative pain, agitation and vomiting.