PARENTAL PRESENCE DURING INDUCTION OF ANESTHESIA VERSUS SEDATIVE PREMEDICATION - WHICH INTERVENTION IS MORE EFFECTIVE

Background: Both midazolam and parental presence during induction of a nesthesia are routinely used to treat preoperative anxiety in children . The purpose of this investigation was to determine which of these tw o interventions is more effective. Methods: Anxiety of the child durin g the perioperative period was the primary end point. Secondary end po ints included anxiety of the parent and compliance of the child during induction. Children (n = 88) were randomly assigned to one of three g roups: (1) 0.5 mg/kg oral midazolam; (2) parental presence during indu ction of anesthesia; or (3) control (no parental presence or premedica tion). Using multiple behavioral measures of anxiety, the effect of th e intervention on the children and their parents was assessed. Results : Observed anxiety in the holding area (T-1), entrance to the operatin g room (T-2), and introduction of the anesthesia mask (T-3) differed s ignificantly among the three groups (P = 0.032). Post hoc analysis ind icated that children in the midazolam group exhibited significantly le ss anxiety compared with the children in the parental-presence group o r control group (P = 0.0171). Similarly, parental anxiety scores after separation were significantly less in the midazolam group compared wi th the parental-presence or control groups (P = 0.048). The percentage of inductions in which compliance of the child was poor was significa ntly greater in the control group compared with the parental-presence and midazolam groups (25% us. 17% vs. 0%, P = 0.013). Conclusions: Und er the conditions of this study, oral midazolam is more effective than either parental presence or no intervention for managing a child's an d parent's anxiety during the preoperative period.