Family-centered Preparation for Surgery Improves Perioperative Outcomes in Children

Department of Pediatrics, Yale University, New Haven, Connecticut, United States
Anesthesiology (Impact Factor: 5.88). 02/2007; 106(1):65-74. DOI: 10.1097/00000542-200701000-00013
Source: PubMed


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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    • "We hypothesized that children who played the educational multimedia application, compared to children in both the comparison and the control groups, would report lower level of preoperative worries about surgery (H1); report high positive emotions, that is, high positive affect (H2) and less subjective arousal (H3); and display reduced physiological indicators of arousal, that is, lower heart rate (H4) and lower blood pressure (H5). According to the literature, parents also experience significant distress and anxiety from their children's illness, fears, and distress, especially during the preoperative period (Kain et al., 2007). Some studies have indicated that parental anxiety can mediate children's preoperative fears and distress (Kain et al., 2000). "
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    ABSTRACT: Surgery is a highly stressful event for children and caregivers. Extensive effort has been made to improve preoperative care in order to alleviate worry about the surgical procedure itself. This study tested the impact of an educational multimedia intervention on the cognitive, emotional, and physiological responses of children undergoing surgery, as well as on parental state anxiety. Children (n = 90) were assigned to three different groups: an educational multimedia intervention (experimental group), an entertainment video game intervention (comparison group), and a control group (no intervention). Children who received the educational multimedia intervention reported lower level of worries about hospitalization, medical procedures, illness, and negative consequences than those in the control and in the comparison groups. Parental state anxiety was also lower in the both the educational and the entertainment video game interventions compared to the control group. These findings suggest that providing information to children regarding medical procedures and hospital rules and routines is important to reduce their preoperative worries, and also relevant for parental anxiety.
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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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