A retrospective cohort study of predictors and interventions that influence cooperation with mask induction in children

Abstract

Background Uncooperative pediatric mask induction is linked to perioperative anxiety. Although some risk factors for uncooperative inductions have been reported, there are no large cohort studies that identify intrinsic patient characteristics associated with cooperation. Aim The primary aim was to identify patient characteristics associated with cooperative mask inductions. The secondary aim was to determine whether preoperative interventions were associated with increased cooperation. Methods This retrospective cohort study included patients 2‐11 years old and ASA class I‐IV who underwent mask induction. Our primary outcome of interest was cooperation with mask induction, which was correlated against the Induction Compliance Checklist. The variables analyzed for association with cooperation were age, sex, ASA class, class of surgery, preferred language, and race. Interventions examined for association with induction cooperation included premedication with midazolam, exposure to distraction technology, parental presence, and the presence of a Child Life Specialist. Multivariate mixed‐effects logistic regression was used to assess the relationship between patient characteristics and cooperation. A separate multivariate mixed‐effects logistic regression was used to examine the association between preoperative interventions and cooperation. Results 9692 patients underwent 23 474 procedures during the study period. 3372 patients undergoing 5980 procedures met inclusion criteria. The only patient characteristic associated with increased cooperation was age (OR 1.20, p‐value 0.03). Involvement of Child Life Specialists was associated with increased cooperation (OR 4.44, p‐value = 0.048) while parental/guardian presence was associated with decreased cooperation (OR 0.38, p‐value = 0.002). Conclusion In this cohort, increasing age was the only patient characteristic found to be associated with increased cooperation with mask induction. Preoperative intervention by a Child Life Specialists was the sole intervention associated with improved cooperation.

Virtual reality for pediatric periprocedural care

“…Implementation of a sustainable virtual reality program requires a team of champions, including physicians, nurses, and certified child life specialists (www.childlife.org/certification). Child life specialists help patients understand and cope with their medical care, leading to increase in cooperation and decrease in anxiety in the perioperative and radiology settings [70][71][72][73]. Each team member should be trained to setup the virtual reality hardware, assess patients for appropriate usage, and be familiar with software choices [74 & ].…”

Child life specialist services, practice, and utilization across health care: a scoping review

“…The geographical spread of studies is captured in the review findings. See Appendix IV for a full list of included studies 7,12–14,16,17,19–25,33–124 …”

A systematic scoping literature review on the use of child life therapy (CLT) in the perioperative setting

“…The accommodations made included the use of a quiet room postoperatively with dimmed lights and the use of service animals. Additional interventions included a web-based preparation programme (Fortier et al 2015), delivered in the child’s home, procedural support (Marquez et al 2012) where the CLS was present for anaesthetic induction and education on coping strategies and relaxation techniques (West et al 2019, Yousef et al 2018).…”