title: Parental intervention choices for children undergoing repeated surgeries.
abstract: No studies have examined parental preference for a preoperative intervention in healthy children undergoing subsequent surgeries. We collected data prospectively from 83 children who previously underwent surgery and were part of an investigation by our study group, then returned for a subsequent surgery. At the initial surgery, children were assigned (no parental intervention) to receive oral midazolam (n = 13), or parental presence during the induction of anesthesia (PPIA, n = 27), or PPIA + midazolam (n = 10) or no intervention (n = 33). At a subsequent surgery, parents chose the preoperative intervention. We found that >80% of all parents chose PPIA (with or without midazolam) at the subsequent surgery regardless of the intervention they received previously. Of parents whose children received PPIA at the initial surgery, 70% chose PPIA again. In contrast, only 23% of the patients who received midazolam at the initial surgery requested midazolam at the subsequent surgery and only 15% of the patients who received no intervention at the initial surgery requested no intervention at the subsequent surgery. All parents of very anxious children at the initial surgery chose some intervention at the subsequent surgery (P = 0.022). Parents of children who underwent a subsequent surgery preferred PPIA regardless of any previous intervention. Also, parents' intervention preferences at the subsequent surgery were influenced by children's anxiety at the initial surgery.
  
  
  CONCLUSIONS
  Parents of children who undergo a subsequent surgery prefer to be present during the induction of anesthesia regardless of whether the child was medicated or had parents present or did not receive anything at the initial surgery. Also, parents' preference for medication or parental presence at the subsequent surgery was influenced by the child's anxiety at the initial surgery.
authors.affiliation: Departments of *Anesthesiology, †Pediatrics, and ‡Child Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
authors.forename: Alison A
authors.initials: AA
authors.lastname: Caldwell-Andrews
authors.forename: Shu-Ming
authors.initials: SM
authors.lastname: Wang
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Krivutza
authors.forename: Megan E
authors.initials: ME
authors.lastname: Weinberg
authors.forename: Linda C
authors.initials: LC
authors.lastname: Mayes
mesh_terms: D000758:Anesthesia / Q000523:psychology; D001007:Anxiety / Q000523:psychology; D001010:Anxiety, Separation / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008137:Longitudinal Studies; D008297:Male; D008874:Midazolam; D009369:Neoplasms / Q000601:surgery; D010290:Parents / Q000523:psychology*; D011229:Preanesthetic Medication; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012086:Reoperation / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology; D013514:Surgical Procedures, Operative / Q000523:psychology*; D013694:Temperament / Q000502:physiology
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam