Article

Family-centered preparation for surgery improves perioperative outcomes in children - A randomized controlled trial

Department of Pediatrics, Yale University, New Haven, Connecticut, United States
Anesthesiology (Impact Factor: 6.17). 02/2007; 106(1):65-74. DOI: 10.1097/00000542-200701000-00013
Source: PubMed

ABSTRACT Children and parents experience significant anxiety and distress during the preoperative period. Currently available interventions are having limited efficacy. Based on an integration of the literature in both the anesthesia and psychological milieus, the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole.
Children and their parents (n = 408) were randomly assigned to one of four groups: (1) control: received standard of care; (2) parental presence: received standard parental presence during induction of anesthesia; (3) ADVANCE: received family-centered behavioral preparation; and (4) oral midazolam. The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium.
Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups (34.4+/-16 vs. 39.7+/-15; P=0.007) and were less anxious during induction of anesthesia as compared with the control and parental presence groups (44.9+/-22 vs. 51.6+/-25 and 53.6+/-25, respectively; P=0.006). Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups (44.9+/-22 vs. 42.9+/-24; P=0.904). Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery (P=0.038), required significantly less analgesia in the recovery room (P=0.016), and were discharged from the recovery room earlier (P=0.04) as compared with children in the three other groups.
The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes.

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    • "Substantial research had been undertaken to identify anxiety-reduction interventions and strategies such as therapeutic relationships and providing surgicalspecific preoperative information and education (Erci, Sezgin, & Kacmaz, 2008; Kain et al., 2007; Ng, Chau, & Leung, 2004; Spaulding, 2003; Stirling, 2006). Other interventions such as application of essential oils, relaxation techniques, and parental presence were also found to be effective in reducing anxiety (Kain et al., 2007; Stirling, 2006). However, it can be noted that most of the strategies and interventions available provide limited evidence for managing preoperative anxiety and stabilizing vital signs among preoperative patients. "
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    • "However, parents are more likely to discuss pharmacologic rather than nonpharmacologic techniques with their health care professionals (Gorodzinsky, Davies, & Drendel, 2014). Therefore, it is essential for nurses to provide information and guidance regarding nonpharmacologic pain relief methods to parents in their children's pain management and remind parents of their role in the management of children's pain (He et al., 2006; He et al., 2007; P€ olkki, 2002; Zisk, Grey, Medoff-Cooper, & Kain, 2007). "
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    • "However, parents are more likely to discuss pharmacologic rather than nonpharmacologic techniques with their health care professionals (Gorodzinsky, Davies, & Drendel, 2014). Therefore, it is essential for nurses to provide information and guidance regarding nonpharmacologic pain relief methods to parents in their children's pain management and remind parents of their role in the management of children's pain (He et al., 2006; He et al., 2007; P€ olkki, 2002; Zisk, Grey, Medoff-Cooper, & Kain, 2007). "
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