Parental presence during induction of anesthesia: physiological effects on parents.
BACKGROUND
The authors conducted a randomized controlled trial to determine whether parental presence during induction of anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress.


METHODS
Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPIA; (2) PPIA plus 0.5 mg/kg oral midazolam; and (3) control (no PPIA or midazolam). The effect of the group assignment on parental heart rate (HR), parental blood pressure, and parental skin conductance level (SCL) were assessed. Both parental HR and parental SCL were monitored continually. Anxiety of the parent and child was also assessed.


RESULTS
Parental HR increased from baseline until the induction of anesthesia (P = 0.001). A group-by-time effect ( P= 0.005) was also found. That is, throughout the induction period there were several time points at which parents in the two PPIA groups had a significantly higher HR than did parents in the control group (P < 0.05). Similarly, SCL was found to increase in all parents from baseline until induction of anesthesia (P = 0.001). Significant group differences in SCL changes over time were found as well (P = 0.009). State anxiety and blood pressure following induction of anesthesia did not differ significantly between groups ( P= nonsignificant). Examination of parental Holter data revealed no rhythm abnormalities and no electrocardiogram changes indicating ischemia.


CONCLUSIONS
The authors found that PPIA is associated with increased parental HR and SCL. However, no increased incidence of electrocardiogram abnormalities were found in parents present during induction of anesthesia.
Kain
Zeev N
ZN
Departments of Anesthesiology, Pediatrics, and Child and Adolescent Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06510, USA. zeev.kain@yale.edu
Caldwell-Andrews
Alison A
AA
Mayes
Linda C
LC
Wang
Shu-Ming
SM
Krivutza
Dawn M
DM
LoDolce
Megan E
ME
D000223:Adaptation, Psychological; D000328:Adult; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000523:psychology*; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D001010:Anxiety, Separation / Q000523:psychology; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D010290:Parents; D011300:Preoperative Care; D011581:Psychological Tests; D018401:Sample Size