Effect of parental presence on anxiety during induction of anaesthesia in children undergoing elective day case surgery

Abstract

Background Surgical operation and anaesthesia induction are fearful events which may interfere with the smooth conduct of anaesthesia and postoperative recovery in children. Indeed, the fear of needles, syringes and unknown hospital environment often compound their anxiety. Various modalities such as use of clowns, music, low intensity light in the induction room, pharmacological agents and parental presence during induction of anaesthesia have been utilized with the aim of gaining the cooperation of the children during induction. However, their use has yielded conflicting results. This prospective study was conducted among children whose ages were between 2 and 15 years. They were randomized into parental presence and parental absence (un-accompanied) or control groups. The anxiety levels of children and parents in both groups were compared at baseline, separation and during induction of anaesthesia. Results The ages of the children ranged between 2 and 15 years with a mean age of 6.78 ± 2.50 years. The mean age of patients in the parental presence at induction (PPIA) was 7.14 ± 3.68 years while in the control group was 6.42 ± 3.31 years. The difference was not statistically significant, p < 0.05. The mean anxiety score of patients in the PPIA at reception, separation and induction of anaesthesia were 26.6 ± 9.2, 38.4 ± 18.3 and 54.1 ± 22.8 compared to 27.3 ± 8.04, 41.4 ± 21.7 and 58.6 ± 23.1 in the control group respectively, p < 0.05. The mean anxiety score of parents in the PPIA at reception, separation and induction of anaesthesia were 52.2 ± 6.7, 51.7 ± 7.8 and 51.9 ± 7.9 compared to 53.0 ± 6.5, 52.4 ± 6.2 and 52.9 ± 7.9 in the control group respectively, p < 0.05. Among the cohort of preschool age group, children in the control group were more anxious at induction compared to the PPIA group, p = 0.01. As the age increases, the anxiety state of the children decreases, t = − 0.398, p < 0.001. The mean score of parental satisfaction in the PPIA and the control groups were comparable, 8.1 ± 7.1 vs 7.3 ± 1.1 respectively, p = 0.395. Conclusion The presence of parents during induction of anaesthesia did not influence the anxiety states of children in our study. Anxiety at induction tends to reduce as the age of patients increases.

Office-Based Pediatric Otoplasty Under Local Anesthesia

“…This theory is supported by the fact that 67% of parents stated the most important reason for choosing otoplasty under LA was due to their ability to be present throughout the procedure. Furthermore, the lack of difference in preoperative and postoperative anxiety levels seen in the parents of the GA subgroup is consistent with the literature which highlighted that parents who were present during induction of their children remained anxious after the operation 28,29…”

“…Furthermore, the lack of difference in preoperative and postoperative anxiety levels seen in the parents of the GA subgroup is consistent with the literature which highlighted that parents who were present during induction of their children remained anxious after the operation. 28,29 It is important to highlight that the safety results of this cohort further corroborates the literature that claims office otoplasty under LA is safe. Studies show that the common medical consequences of otoplasty involve hematoma, bleeding, postoperative infections, perichondritis, dehiscence, skin necrosis, excessive scarring, suture extrusion, hypersensitivity, and poor esthetic outcomes.…”

“…Currently, the majority of the senior author's pediatric otoplasties (5-10 y of age) are done under LA alone. Furthermore, parents had marginally higher anxiety levels before otoplasty was done under GA compared with LA; this is understandable, as parents tend to be anxious when their children have to undergo GA. 28,29 Interestingly, parents of the GA subgroup had higher postoperative anxiety levels compared with postoperative anxiety in parents of the LA subgroup. This may be due to the parents' ability to stay with their children when otoplasty is performed under LA alone, which may diffuse anxiety about the possible trauma their children may experience intraoperatively.…”

“…Furthermore, parents had marginally higher anxiety levels before otoplasty was done under GA compared with LA; this is understandable, as parents tend to be anxious when their children have to undergo GA 28,29. Interestingly, parents of the GA subgroup had higher postoperative anxiety levels compared with postoperative anxiety in parents of the LA subgroup.…”