Parental presence and a sedative premedicant for children undergoing surgery - A hierarchical study

Background Although some anesthesiologists use oral sedatives or parental p resence during induction of anesthesia (PPIA) to treat preoperative anxiety in children, others may use these interventions simultaneously (eg., sedat ives and PPIA). The purpose of this investigation was to determine whether this approach has advantages over treating children with sedatives alone. Methods: The child's and the parental anxiety throughout the perioperative period was the primary endpoint of the study. Parental satisfaction was the secondary endpoint. Subjects (n = 103) were assigned randomly to one of tw o groups: a sedative group (0.5 mg/kg oral midazolam) or a sedative and PPI A group. Using standardized measures of anxiety and satisfaction, the effec ts of the interventions on the children and parents were assessed. Statisti cal analysis (varimax rotation) of the satisfaction questionnaire items res ulted in two factors that described satisfaction of the separation process and satisfaction of the overall care provided. \ Results: Anxiety in the ho lding area, at entrance to the operating room, and at introduction of the a nesthesia mask did not differ significantly between the two groups (F[2,192 ] = 1.26,P = 0.28). Parental anxiety after separation, however, was signifi cantly lower in the sedative and PPIA group (F[2,93] = 4.46, P = 0.037). Pa rental satisfaction with the overall care provided (-0.28 +/- 1.2 vs. 0.43 +/- 0.26, P = 0.046) and with the separation process (-0.30 +/- 1.2 vs. 0.4 7 +/- 0.20, P = 0.03) was significantly higher among the sedative and PPIA group compared with the sedative group. Conclusions: PPIA in addition to 0.5 mg/kg oral midazolam has no additive e ffects in terms of reducing a child's anxiety. Parents who accompanied thei r children to the operating room, however, were less anxious and more satis fied.