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 p2 = .07. At anesthetic induction, the I-PPP group demonstrated lower observer-rated anxiety than TAU, F(1, 64) = 4.72, p = .034, η p2 = .07. I-PPP group demonstrated the best anesthesia induction compliance, F(1, 64) = 4.84, p = .031, η p2 = .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 ).

Randomized-controlled trial of parent-led exposure to anesthetic mask to prevent child preoperative anxiety.

PURPOSE: To examine the efficacy of parent-directed anesthetic mask exposure and shaping practice to prevent child preoperative anxiety, with a specific focus on timing of exposure. METHODS: This randomized-controlled trial included 110 children ages four to seven years undergoing day surgery dental procedures and their parents. Families were randomly assigned to one of three groups: 1) parent-directed mask exposure/shaping practice at least three times in the week prior to surgery (Group 1); 2) parent-directed mask exposure/shaping practice at least once on the day of surgery (Group 2); 3) no exposure prior to induction (Group 3). Child anxiety was observer-rated using the modified Yale Preoperative Anxiety Scale during the day surgery experience, and induction compliance was observer-rated using the Induction Compliance Checklist. RESULTS: Results demonstrated significant differences in observer-rated child anxiety at anesthetic induction across groups. Group 2 demonstrated significantly lower observer-rated anxiety than Group 3 with a medium effect, F(1, 71) = 4.524, P = 0.04, η p 2 = 0.06. A significant interaction was observed between these two groups over time (i.e., admission to anesthesia induction), F(1, 71) = 4.365, P = 0.04, η p 2 = 0.06 (i.e., small to medium effect). Group 2 demonstrated the best anesthesia induction compliance (i.e., significantly lower scores than Group 3, P = 0.04). CONCLUSION: Timing of the delivery of mask exposure (i.e., on the day of surgery) to address child preoperative anxiety and induction compliance in the day surgery setting may be an important consideration. The current results inform the integration of this simple, effective strategy into practice.

RéSUMé: OBJECTIF: Examiner l'efficacité d'une exposition au masque anesthésique menée par un parent et détermination d'une pratique visant à prévenir l'anxiété préopératoire de l'enfant en se concentrant spécifiquement sur le moment de l'exposition. MéTHODES: Cette étude randomisée contrôlée a inclus 110 enfants âges de quatre à sept ans subissant une procédure dentaire en chirurgie d'un jour et leurs parents. Après randomisation, les familles ont été assignées à l'un des trois groupes suivants : 1) exposition au masque/pratique de modelage comportemental dirigée par le parent au moins trois fois dans la semaine précédant l'intervention (Groupe 1); 2) exposition au masque/pratique de modelage comportemental dirigée par le parent au moins une fois le jour de la chirurgie (Groupe 2); 3) aucune exposition avant l'induction (Groupe 3). L'anxiété de l'enfant a été évaluée par un observateur utilisant l'échelle mYPAS (échelle modifiée d'anxiété préopératoire de Yale) au cours de l'expérience le jour de la chirurgie et la conformité de l'induction a été évaluée par un observateur utilisant l'ICC (liste de vérification de la conformité de l'induction). RéSULTATS: Les résultats ont mis en évidence des différences significatives entre les groupes sur l'anxiété de l'enfant évaluée par un observateur au moment de l'induction anesthésique. Le Groupe 2 a présenté une anxiété évaluée par l'observateur significativement inférieure à celle du Groupe 3 avec un effet médian F (1, 71) = 4,524, P = 0,04, η P 2 = 0,06. Une interaction significative a été observée entre ces deux groupes au fil du temps (c'est-à-dire entre l'admission et l'induction de l'anesthésie), F (1, 71) = 4,365, P = 0,04, η P 2 = 0,06 (soit un effet petit à moyen). Le Groupe 2 a manifesté la meilleure conformité de l'induction de l'anesthésie (c'est-à-dire, des scores significativement inférieurs au Groupe 3, P = 0,04). CONCLUSION: Il peut être important de tenir compte du moment de l'exposition au masque (c'est-à-dire le jour de l'intervention) pour répondre à l'anxiété préopératoire de l'enfant et à la conformité de l'induction dans le cadre de la chirurgie d'un jour. Les résultats actuels renseignent sur l'intégration de cette stratégie simple et efficace dans la pratique.

Internet-delivered, preoperative, preparation program (I-PPP): Development and examination of effectiveness.

STUDY OBJECTIVE: Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to develop and examine the effectiveness of the Internet-delivered, preoperative program (I-PPP) in alleviating prepoperative anxiety in children undergoing outpatient surgery. In Study 1, the I-PPP was developed and then evaluated by parent/child dyads and health care professionals. In Study 2, the effectiveness of I-PPP was examined. DESIGN: This study was a development and effectiveness study. SETTING: For Study 1, participants were recruited from the community. For Study 2, participants were recruited from the Royal University Hospital. PATIENTS: In Study 1, participants were 9 parent/child dyads and 5 health care professionals. In Study 2, participants were 32 children (3-7years) scheduled for outpatient surgery and one parent for each child. INTERVENTION: In Study 1, I-PPP modules were created and parent/child dyads and health care professionals evaluated I-PPP modules and treatment credibility. In Study 2, child patients and their parents completed the I-PPP prior to day of surgery. MEASUREMENTS: Observer-rated anxiety of child participants was measured during the day surgery experience. Parent state anxiety was measured prior to completing I-PPP, pre- and post-surgery. Post-surgery parents provided comments regarding the I-PPP. Post-surgery child behaviour change was assessed. MAIN RESULTS: For Study 1, ratings for I-PPP components and treatment credibility surpassed our acceptability criterion. Minor changes were made to I-PPP. For Study 2, mYPAS scores were stable across day surgery. mYPAS scores in current study at induction did not differ significantly from benchmark studies. Significant reduction in parent anxiety was observed pre- to post-surgery. Parents positively endorsed the program. Negative post-operative behaviours were observed in a proportion of children. CONCLUSIONS: Our findings suggest that I-PPP represents a viable option for preoperative preparation for children and their parents.