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Matava CT, Bordini M, Sullivan BO, Garcia-Tejedor GA, Gai N, Petroz G, Donnell CM, Alam F, Brazel K, Caldeira-Kulbakas M. Virtual parental presence with coaching for reducing preoperative anxiety in children: a feasibility and pilot randomized controlled trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844533. [PMID: 38942079 PMCID: PMC11269778 DOI: 10.1016/j.bjane.2024.844533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Preoperative anxiety in children causes negative postoperative outcomes. Parental presence at induction is a non-pharmacological strategy for relieving anxiety; nevertheless, it is not always possible or effective, namely when parents are overly anxious. Parental presence via video has been demonstrated to be useful in other contexts (divorce, criminal court). This study reports the feasibility of a randomized controlled trial to investigate the effect of video parental presence and parental coaching at induction on preoperative anxiety. METHODS The study was a randomized, 2 × 2 factorial design trial examining parental presence (virtual vs. physical) and coaching (provided vs. not provided). Feasibility was assessed by enrollment rate, attrition rate, compliance, and staff satisfaction with virtual method with the NASA-Task Load Index (NASA-TLX) and System Usability Scale (SUS). For the children's anxiety and postoperative outcomes, the modified Yale Preoperative Anxiety Scale (mYPAS) and Post-Hospitalization Behavioral Questionnaire (PHBQ) were used. Parental anxiety was evaluated with the State-Trait Anxiety Inventory (STAI) questionnaire. RESULTS A total of 41 parent/patient dyads were recruited. The enrollment rate was 32.2%, the attrition rate 25.5%. Compliance was 87.8% for parents and 85% for staff. The SUS was 67.5/100 and 63.5/100 and NASA-TLX was 29.2 (21.5-36.8) and 27.6 (8.2-3.7) for the anesthesiologists and induction nurses, respectively. No statistically significant difference was found in mYPAS, PHBQ and STAI. CONCLUSION A randomized controlled trial to explore virtual parental presence effect on preoperative anxiety is feasible. Further studies are needed to investigate its role and the role of parent coaching in reducing preoperative anxiety.
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Affiliation(s)
- Clyde T Matava
- The Hospital for Sick Children, Department of Anesthesia, Toronto, Ontario, Canada; University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, Ontario, Canada.
| | - Martina Bordini
- The Hospital for Sick Children, Department of Anesthesia, Toronto, Ontario, Canada; University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, Ontario, Canada; University of Bologna, Department of Medical and Surgical Sciences (DIMEC), Bologna, Italy
| | - Ben O' Sullivan
- The Hospital for Sick Children, Department of Anesthesia, Toronto, Ontario, Canada
| | | | - Nan Gai
- The Hospital for Sick Children, Department of Anesthesia, Toronto, Ontario, Canada; University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, Ontario, Canada
| | - Guy Petroz
- The Hospital for Sick Children, Department of Anesthesia, Toronto, Ontario, Canada
| | - Conor Mc Donnell
- The Hospital for Sick Children, Department of Anesthesia, Toronto, Ontario, Canada
| | - Fahad Alam
- University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Department of Anesthesia, Toronto, Ontario, Canada
| | - Katie Brazel
- Hospital for Sick Children, Child Life Department, Toronto, Ontario, Canada
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Shaw RE, Krause BM, Ferguson J, Muldowney BL. Differential Utilization of Parental Presence and Premedication for Induction of Anesthesia in Pediatric Patients. J Perianesth Nurs 2024; 39:672-678. [PMID: 38363269 DOI: 10.1016/j.jopan.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE Known disparities exist in pain treatment between African American, Latino, and White children. A recent study described 'adultification' of Black children, with Black children being less likely to have a parent present at induction of anesthesia and less likely to receive an anxiolytic premedication before proceeding to the operating room. The aim of this study is to identify differences based on race and socioeconomic status when treating children and their families for anesthetic induction. We hypothesize that differences exist such that certain populations are less likely to receive sedative premedication and less likely to have parents present at induction of anesthesia. DESIGN This was a retrospective cohort study. METHODS Demographic data were obtained along with type of surgical procedure, type of anesthesia induction, use of premedication, and involvement of child life services (including the plan for parental presence at induction) for all pediatric patients presenting for anesthetics from February 2019 to March 2020. Statistical analysis consisted of fitting logistic mixed effects models for caregiver presence or for midazolam use during induction, with fixed effects for sex, race, ethnicity, language, public/private insurance, and anesthetic risk, and with the provider as a random effect. FINDINGS A total of 7,753 patients were included in our statistical analyses, and parental presence focused on 4,102 patients with documentation from child life specialists. Females were less likely than males to have parents present at induction (odds ratio [OR] 0.77, confidence interval [CI] [0.67, 0.89]). When looking at race, American Indian/Alaskan Native patients (OR 0.23 [CI 0.093, 0.47]) and Black/African American patients OR 0.64 [CI 0.47, 0.89]) were less likely to have a parent present induction than White patients. Patients with private insurance were more likely to have parents present than patients with public insurance (OR 0.63 CI [0.5, 0.78]). These findings held true in age-separated sensitivity analysis. Asian patients were less likely to receive midazolam premedication (OR 0.65 CI [0.49, 0.86]). CONCLUSIONS This study supports previous work showing differential use of parental presence at induction based on race. Additionally, it also shows different treatment based on sex and public insurance status, a surrogate for socioeconomic status.
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Affiliation(s)
- Robert E Shaw
- University of Wisconsin, School of Medicine and Public Health, Department of Anesthesiology, Division of Pediatric Anesthesia, Madison, WI.
| | - Bryan M Krause
- University of Wisconsin, School of Medicine and Public Health, Department of Anesthesiology, Madison, WI
| | - Janice Ferguson
- UW Health, American Family Children's Hospital, Department of Child Life Services, Madison, WI
| | - Bridget L Muldowney
- University of Wisconsin, School of Medicine and Public Health, Department of Anesthesiology, Division of Pediatric Anesthesia, Madison, WI
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Yucedag F, Sezgin A, Bilge A, Basaran B. The effect on perioperative anxiety and emergence delirium of the child or parent's preference for parental accompaniment during anesthesia induction in children undergoing adenotonsillectomy surgery. Paediatr Anaesth 2024; 34:792-799. [PMID: 38676358 DOI: 10.1111/pan.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Pediatric emergence delirium (ED) occurs in the early postoperative period and is defined as a complex psychiatric disorder. Non-pharmacological methods of treatment, such as perioperative parental presence, have been the focus of many studies, but the impact on preventing ED of which parent accompanies the child during anesthesia induction has not been identified as yet. Therefore, the aim of this study was to determine whether the selection made by children undergoing adenotonsillectomy of which parent will accompany them during anesthesia induction has the effect of reducing postoperative delirium scores and incidence compared to selections made by the parents. METHODS The study included 80 children of both genders, aged 5-12 years, who underwent day-case surgery in the otorhinolaryngology clinic. The patients were separated randomly into two groups of 40. In Group 1, the children were asked to choose which of their parents would accompany them during general anesthesia induction, and in Group 2, the parents were asked to decide who would be the accompanying parent. Evaluation of postoperative delirium was made using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The anxiety level of the children was evaluated with the modified Yale Preoperative Anxiety Scale (mYPAS) both in the preoperative waiting area and during the anesthesia induction. The State-Trait Anxiety Inventory (STAI) was used to evaluate the anxiety level of the parents. RESULTS The mean PAED scores were similar in both groups (mean difference [95% CI]: -0.1 [-2.8 to 0.7]). The incidence of emergence delirium was also similar in both groups (risk ratio 0.9 [0.4 to 1.8]). The mean mYPAS scores during the induction of anesthesia of Group 1 was lower than that of Group 2 (mean difference [95% CI]: -8.4 [-15.2 to -1.6]). The mean mYPAS scores evaluated in the preoperative waiting area were found to be similar in the two groups (mean difference [95% CI]: -1.9 [-7.5 to 3.5]). The mean STAI anxiety scores of the parents were similar in both groups, with higher scores obtained by mothers compared to fathers, at all measurement times. CONCLUSION The incidence or severity of ED did not decrease significantly even though lower anxiety scores were obtained during anesthesia induction in children who were allowed to make the decision of accompanying parent. Based on these findings, it can be concluded that postoperative delirium is a more complicated process that can be affected by many other variables rather than just the parent-child general interaction.
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Affiliation(s)
- Fatih Yucedag
- Department of Otorhinolaryngology, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Arife Sezgin
- Department of Otorhinolaryngology, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Aysegul Bilge
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Betul Basaran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
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Fatih Y, Arife S, Aysegul B, Betul B. The Effect of Child Preference for Parental Selection on Pediatric Anxiety During Induction in Children Undergoing Elective Day Case Surgery. J Perianesth Nurs 2024; 39:397-402. [PMID: 38054915 DOI: 10.1016/j.jopan.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/05/2023] [Accepted: 08/26/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The aim of the study was to determine if children were given the right to prefer one parent to accompany them during the perioperative period would impact their anxiety levels. DESIGN Prospective observational cohort study. METHODS The study included 80 children of both genders, aged 4 to 12 years, who underwent day-case surgeries in the Ear Nose and Throat Clinic of Karaman Training and Research Hospital. The patients were separated randomly into two groups of 40. In Group 1, children were asked which of their parents would accompany them during general anesthesia induction, and in Group 2, the child' preference was not asked, and "accompanying parent" was randomly selected by the physician. The anxiety level of the children was evaluated with the modified Yale Preoperative Anxiety Scale (mYPAS) both in the preoperative waiting area and during the anesthesia induction. The State-Trait Anxiety Inventory (STAI) was used to determine the anxiety level of their parents. FINDINGS The mean mYPAS score during the induction of anesthesia of Group 1 was significantly lower than that of Group 2 (38.1 vs 45.2; P = .034). There was no difference between the two groups in the mean mYPAS scores evaluated in the preoperative waiting area (38.0 vs 39.1; P = .761). The mean anxiety scores of the parents evaluated using the STAI were similar in both groups, with higher scores between mothers compared to fathers at all measurement times. No difference was determined between the two groups regarding the mean mYPAS scores according to the gender of the child during the perioperative period (P > .05). There was a significant decrease in the mean STAI scores in the preoperative waiting area with an increase in parent's education level (P = .011), but the educational level had no effect on the scores during the induction of anesthesia. CONCLUSIONS Significantly lower anxiety scores were recorded during the induction of anesthesia for the children who had a chance to select their accompanying parent before surgery. Thus, the overall interaction between the child and the parent before the perioperative period may be accepted as an important factor for the reduction of anxiety during anesthesia induction.
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Affiliation(s)
- Yucedag Fatih
- Department of Otorhinolaryngology, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey.
| | - Sezgin Arife
- Department of Otorhinolaryngology, Karaman Education and Training Hospital, Karaman, Turkey
| | - Bilge Aysegul
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Basaran Betul
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman, Turkey
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Baek J, Kim YM. The Impact of Parental Presence on Emergence Delirium in Pediatric Patients After General Anesthesia: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024; 39:475-483. [PMID: 38219079 DOI: 10.1016/j.jopan.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE This study reviewed existing literature on parental presence in cases of pediatric patients after general anesthesia and explored its effect on emergence delirium (ED) in the postanesthesia care unit (PACU). DESIGN Systematic review and meta-analysis. METHODS After protocol registration, we searched the PubMed, EMBASE, CINHAL, Web of Science, SCOPUS, and CENTRAL databases. Two authors independently searched and selected the relevant studies, assessed their risk of bias, and abstracted the data. The primary outcome was ED, and the additional outcome was pain. We provided the narrative synthesis and meta-analysis results. FINDINGS Of the 296 articles retrieved, 6 were included in the narrative synthesis, and 5 were used for the meta-analysis. Four studies were randomized controlled trials, and two studies were nonrandomized controlled trials. There were 348 pediatric patients in the parental presence group and 314 pediatric patients in the usual care group. Parental presence effectively reduced the ED score (mean difference, -0.58; 95% confidence interval [CI], -0.84 to -0.31; P < .001). The ED incidence rate (log odds ratio, -0.58; 95% CI, -1.24 to 0.09; P = .090) and pain score (standardized mean difference, -0.24; 95% CI, -0.57 to 0.10; P = .163) were lower in the parental presence group than in the usual care group. However, the differences were not statistically significant. CONCLUSIONS The presence of parents in the PACU can reduce ED in pediatric patients. Therefore, parental presence may be a useful intervention in the PACU.
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Affiliation(s)
- Jihyun Baek
- College of Nursing, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Young Man Kim
- College of Nursing, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea; Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju-si, Jeollabuk-do, Republic of Korea.
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Wong GSK, Cobain C, Pawa A. You don't know what you've got 'til it's gone: why anaesthetic rooms should stay. Anaesthesia 2024; 79:469-472. [PMID: 38214367 DOI: 10.1111/anae.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Affiliation(s)
- G S K Wong
- Department of Theatres, Anaesthesia and Peri-operative Medicine, Guy's St Thomas' NHS Foundation Trust, London, UK
| | - C Cobain
- Department of Theatres, Anaesthesia and Peri-operative Medicine, Guy's St Thomas' NHS Foundation Trust, London, UK
| | - A Pawa
- Department of Theatres, Anaesthesia and Peri-operative Medicine, Guy's St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Arredondo Montero J, Bardají Pascual C. From Aviation to Pediatric Surgery. Clin Pediatr (Phila) 2024; 63:557-559. [PMID: 37246755 DOI: 10.1177/00099228231176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Aviation is a tremendously complex process involving multiple factors that can be subsidiary to human error. The implementation of checklists, tools that reduce this risk, has often been extrapolated to other fields, especially medicine. Through this reflection, we comment on the critical and relevant aspects of pediatric surgical patient safety, briefly discussing the existing literature and analyzing potential areas for improvement.
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Affiliation(s)
| | - Carlos Bardají Pascual
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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Almerud Österberg S, Andersson L. I saw myself as an important piece of a jigsaw puzzle: Parents experiences of their child's anaesthesia induction. J Child Health Care 2023:13674935231218039. [PMID: 38009249 DOI: 10.1177/13674935231218039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Anxiety in children, as well as their parents, is common in high-tech environments such as an operating room. This study aimed to describe parents' experiences of being present when their child is being anaesthetised. Twenty-four parents were interviewed and data were analysed using a descriptive phenomenological approach. Findings show that being present at a child's anaesthesia and surgery is a long, continuous process that begins at home. Parents struggle to face strong emotions in a special and frightening environment, focussing on their child's well-being while trying to remain control in this situation. Security and trust are vital, but it's challenging to relinquish control in an uncertain situation. Professional caregivers can promote trust and participation, but an awareness that something can go wrong affects parents on a deep level. In conclusion, parental presence at induction of anaesthesia is important but can be overwhelming and anxiety-inducing for some parents. Parents should be seen as a resource rather than a disturbance. Overall, the healthcare system should prioritise parents' involvement and seek to create an environment where they feel supported and included.
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Affiliation(s)
- Sofia Almerud Österberg
- Department of Anesthesiology, Region Kronoberg, Vaxjo, Sweden
- Department of Health and Caring Science, Linnaeus University, Vaxjo, Sweden
| | - Lisbet Andersson
- Department of Health and Caring Science, Linnaeus University, Vaxjo, Sweden
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Ejiri H, Imura H, Baba R, Sumi A, Koga A, Kanno K, Kunimoto M, Hayami K, Niimi T, Nomoto S, Natsume N. Parental Accompaniment in Operating Rooms Reduces Child Anxiety. Healthcare (Basel) 2023; 11:2289. [PMID: 37628487 PMCID: PMC10454404 DOI: 10.3390/healthcare11162289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND We believe that parental presence before the induction of anesthesia for surgery among children with a cleft palate/lip would be effective in mitigating their preoperative anxiety. OBJECTIVE We assessed the states of patients with a cleft palate/lip when their parents accompanied them into operating rooms and clarified their and their parents' cognition using a questionnaire. METHODS Data were collected via nursing observation when patients and their parents entered the operating room. Furthermore, an anonymous questionnaire was administered to patients and parents after the operation regarding their feelings about parental presence in the operating room. RESULTS In total, nine patients cried when they entered the surgical room. Furthermore, six patients and three parents reported preoperative anxiety. In addition, eight patients agreed that they were satisfied with the presence of their parents before induction. CONCLUSION Approximately half of the patients cried. However, the presence of parents before the induction of anesthesia was effective in reducing anxiety among most patients and their parents.
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Affiliation(s)
- Harumi Ejiri
- College of Life and Health Sciences, Chubu University, 1200 Matsumoto, Kasugai 487-8501, Aichi, Japan;
| | - Hideto Imura
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, 2-11, Suemori-Dori, Chikusa-ku, Nagoya 464-8651, Aichi, Japan; (H.I.); (T.N.); (N.N.)
| | - Reizo Baba
- College of Life and Health Sciences, Chubu University, 1200 Matsumoto, Kasugai 487-8501, Aichi, Japan;
| | - Akiko Sumi
- Hokkaido University Hospital, Kita14, Nishi5, Kita-ku, Sapporo 060-8648, Hokkaido, Japan; (A.S.); (M.K.)
| | - Akiko Koga
- Japanese Cleft Palate Foundation, 2-5 Hoocho, Chikusa-ku, Nagoya 464-0057, Aichi, Japan
| | - Kaoru Kanno
- Japanese Cleft Palate Foundation, 2-5 Hoocho, Chikusa-ku, Nagoya 464-0057, Aichi, Japan
| | - Miho Kunimoto
- Hokkaido University Hospital, Kita14, Nishi5, Kita-ku, Sapporo 060-8648, Hokkaido, Japan; (A.S.); (M.K.)
| | - Kayo Hayami
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, 2-11, Suemori-Dori, Chikusa-ku, Nagoya 464-8651, Aichi, Japan; (H.I.); (T.N.); (N.N.)
| | - Teruyuki Niimi
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, 2-11, Suemori-Dori, Chikusa-ku, Nagoya 464-8651, Aichi, Japan; (H.I.); (T.N.); (N.N.)
| | - Shuji Nomoto
- Department of Surgery, School of Dentistry, Aichi Gakuin University, 2-11, Suemori-Dori, Chikusa-ku, Nagoya 464-8651, Aichi, Japan;
| | - Nagato Natsume
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, 2-11, Suemori-Dori, Chikusa-ku, Nagoya 464-8651, Aichi, Japan; (H.I.); (T.N.); (N.N.)
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Alcaraz Garcia-Tejedor G, Le M, Tackey T, Watkins J, Caldeira-Kulbakas M, Matava C. Experiences of Parental Presence in the Induction of Anesthesia in a Canadian Tertiary Pediatric Hospital: A Cross-Sectional Study. Cureus 2023; 15:e36246. [PMID: 36937125 PMCID: PMC10019788 DOI: 10.7759/cureus.36246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/18/2023] Open
Abstract
Background Parental presence at induction of anesthesia remains controversial and has been reported to provide mixed results. As such, parental presence at induction of anesthesia is not practiced routinely everywhere. There are currently limited data describing the practice of parental presence at induction of anesthesia or the experiences and perceptions of parents in Canada. Objectives We sought to investigate (1) the frequency of parental presence at induction of anesthesia and (2) the experiences and perceptions of parents accompanying their child into the operating room compared to those who did not at a tertiary Canadian pediatric hospital. Methods Institutional quality improvement approval was obtained. This study was a cross-sectional survey. Parents waiting in the parent surgical waiting room during the procedure were invited to complete a web-based survey. Consent was implied via completing the survey. The cross-sectional survey elicited the prevalence of parental presence during induction of anesthesia as well as their experience and perceptions. We also investigated the parents' preferences for preoperative education. Results Of the 448 parents approached, 403 completed the survey between May and June 2017. Sixty-eight (16.9% [13.4-20.9]) parents accompanied their child into the operating room (parental presence at induction of anesthesia), while 335/403 (83.1% [79.1-86.7]) did not (no-parental presence at induction of anesthesia). Reasons for not accompanying their child into the operating room included "not being aware they could" (158/335, 47.2% [41.9-52.5]), "I didn't think my child needed me" (107/335, 31.9% [27.2-37.1]), "my child was coping well" (46/335, 13.4% [10.5-17.8]), and "I was anxious" (47/335, 14.0% [10.7-18.2]). Most of the parents in the parental presence at induction of anesthesia cohort (66/67, 98.5% [95.6-101.2]) reported that they believed their child benefited/would have benefited from their presence during induction of anesthesia compared to those in the no-parental presence at induction of anesthesia cohort (137/335, 40.9% [35.8-46.2]), P < 0.001. Overall, 51/335 (14.7%) parents in the no-parental presence at induction of anesthesia cohort and 3/67 (4.5%) of those in the parental presence at induction of anesthesia cohort felt that offering parental presence at induction of anesthesia should depend on factors including child's age as well as the level of coping and anxiety. More patients in the no-parental presence at induction of anesthesia cohort felt that parental presence at induction of anesthesia should also depend on the child's age and whether the child was coping. Parents felt that face-to-face discussions with clinicians are most effective for discussing future parental presence at induction of anesthesia. Conclusions We have shown that most parents at our institution do not undergo parental presence at induction of anesthesia and are for the most part comfortable with their child going unaccompanied into the operating room. Administrators and clinicians seeking to implement parental presence policies should consider navigating parental presence at induction of anesthesia with evidence-based approaches tailored to each parent and their child.
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Affiliation(s)
| | - Matthew Le
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
| | - Theophilus Tackey
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
| | - Jessica Watkins
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
| | | | - Clyde Matava
- Anesthesiology and Pain Medicine, University of Toronto, Toronto, CAN
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
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