title: Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes.
authors.affiliation: Center for the Advancement of Perioperative Health and the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA. zeev.kain@yale.edu
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
authors.forename: Alison A
authors.initials: AA
authors.lastname: Caldwell-Andrews
authors.forename: Linda C
authors.initials: LC
authors.lastname: Mayes
authors.forename: Megan E
authors.initials: ME
authors.lastname: Weinberg
authors.forename: Shu-Ming
authors.initials: SM
authors.lastname: Wang
authors.forename: Jill E
authors.initials: JE
authors.lastname: MacLaren
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Blount
mesh_terms: D000700:Analgesics / Q000008:administration & dosage; D001007:Anxiety / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003693:Delirium / Q000453:epidemiology / Q000517:prevention & control*; D005190:Family; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D011997:Recovery Room; D013997:Time Factors
chemical_list: D000700:Analgesics