Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995-2002: results of a follow-up national survey.

UNLABELLED: Both parental presence during induction of anesthesia and sedative premedication are currently used to treat preoperative anxiety in children. A survey study conducted in 1995 demonstrated that most children are taken into the operating room without the benefit of either of these two interventions. In 2002 we conducted a follow-up survey study. Five thousand questionnaires were mailed to randomly selected physician members of the American Society of Anesthesiologists. Mailings were followed by a nonresponse bias assessment. Twenty-seven percent (n = 1362) returned the questionnaire after 3 mailings. We found that a significantly larger proportion of young children undergoing surgery in the United States were reported to receive sedative premedication in 2002 as compared with 1995 (50% vs 30%, P = 0.001). We also found that in 2002 there was significantly less geographical variability in the use of sedative premedication as compared with the 1995 survey (F = 8.31, P = 0.006). Similarly, we found that in 2002 parents of children undergoing surgery in the United States were allowed to be present more often during induction of anesthesia as compared with 1995 (chi(2) = 26.3, P = 0.0001). Finally, similar to our findings in the 1995 survey, midazolam was uniformly selected most often to premedicate patients before surgery. IMPLICATIONS: Over the past 7 yr there have been significant increases in the number of anesthesiologists who use preoperative sedative premedication and parental presence for children undergoing surgery.

Interactive music therapy as a treatment for preoperative anxiety in children: a randomized controlled trial.

UNLABELLED: In this study, we examined whether interactive music therapy is an effective treatment for preinduction anxiety. Children undergoing outpatient surgery were randomized to 3 groups: interactive music therapy (n = 51), oral midazolam (n = 34), or control (n = 38). The primary outcome of the study was children's perioperative anxiety. We found that children who received midazolam were significantly less anxious during the induction of anesthesia than children in the music therapy and control groups (P = 0.015 and P = 0.005, respectively). We found no difference in anxiety during the induction of anesthesia between children in the music therapy group and children in the control group. An analysis controlling for therapist revealed a significant therapist effect; i.e., children treated by one of the therapists were significantly less anxious than children in the other therapist group and the control group on separation to the operating room (OR) (P < 0.05) and on entrance to the OR (P < 0.05), but not on the introduction of the anesthesia mask (P = not significant). Children in the midazolam group were the least anxious even after controlling for therapist effect (P < 0.05). We conclude that music therapy may be helpful on separation and entrance to the OR, depending on the therapist. However, music therapy does not appear to relieve anxiety during the induction of anesthesia. IMPLICATIONS: Depending on the music therapist, interactive music therapy may relieve anxiety on separation and entrance to the operating room but appears less effective during the induction of anesthesia.

Parental intervention choices for children undergoing repeated surgeries.

UNLABELLED: No studies have examined parental preference for a preoperative intervention in healthy children undergoing subsequent surgeries. We collected data prospectively from 83 children who previously underwent surgery and were part of an investigation by our study group, then returned for a subsequent surgery. At the initial surgery, children were assigned (no parental intervention) to receive oral midazolam (n = 13), or parental presence during the induction of anesthesia (PPIA, n = 27), or PPIA + midazolam (n = 10) or no intervention (n = 33). At a subsequent surgery, parents chose the preoperative intervention. We found that >80% of all parents chose PPIA (with or without midazolam) at the subsequent surgery regardless of the intervention they received previously. Of parents whose children received PPIA at the initial surgery, 70% chose PPIA again. In contrast, only 23% of the patients who received midazolam at the initial surgery requested midazolam at the subsequent surgery and only 15% of the patients who received no intervention at the initial surgery requested no intervention at the subsequent surgery. All parents of very anxious children at the initial surgery chose some intervention at the subsequent surgery (P = 0.022). Parents of children who underwent a subsequent surgery preferred PPIA regardless of any previous intervention. Also, parents' intervention preferences at the subsequent surgery were influenced by children's anxiety at the initial surgery. IMPLICATIONS: Parents of children who undergo a subsequent surgery prefer to be present during the induction of anesthesia regardless of whether the child was medicated or had parents present or did not receive anything at the initial surgery. Also, parents' preference for medication or parental presence at the subsequent surgery was influenced by the child's anxiety at the initial surgery.

Parental presence during induction of anesthesia: physiological effects on parents.

BACKGROUND: The authors conducted a randomized controlled trial to determine whether parental presence during induction of anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress. METHODS: Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPIA; (2) PPIA plus 0.5 mg/kg oral midazolam; and (3) control (no PPIA or midazolam). The effect of the group assignment on parental heart rate (HR), parental blood pressure, and parental skin conductance level (SCL) were assessed. Both parental HR and parental SCL were monitored continually. Anxiety of the parent and child was also assessed. RESULTS: Parental HR increased from baseline until the induction of anesthesia (P = 0.001). A group-by-time effect ( P= 0.005) was also found. That is, throughout the induction period there were several time points at which parents in the two PPIA groups had a significantly higher HR than did parents in the control group (P < 0.05). Similarly, SCL was found to increase in all parents from baseline until induction of anesthesia (P = 0.001). Significant group differences in SCL changes over time were found as well (P = 0.009). State anxiety and blood pressure following induction of anesthesia did not differ significantly between groups ( P= nonsignificant). Examination of parental Holter data revealed no rhythm abnormalities and no electrocardiogram changes indicating ischemia. CONCLUSIONS: The authors found that PPIA is associated with increased parental HR and SCL. However, no increased incidence of electrocardiogram abnormalities were found in parents present during induction of anesthesia.