Parental Presence during introduction of Anesthesia improves compliance of the child and Reduces Emergence Delirium

Infographic · Sep 2022 · 1 min read

In brief

Study of 638 pediatric surgical patients demonstrates that combining parental presence during anesthesia induction with midazolam premedication achieves optimal compliance (81% perfect induction) and significantly reduces emergence delirium incidence and intensity compared to no intervention.

Parental presence during induction combined with midazolam premedication achieved 81% perfect compliance (ICC=0) in pediatric patients.
PPIA+MDZ reduced emergence delirium incidence (OR 10.5) and severity (1.2 vs 5.8) compared to no intervention in ambulatory surgery.
Combined approach (parent presence + midazolam) decreased preoperative anxiety (m-YPAS=26) more effectively than either strategy alone.
Study of 638 ASA I-II pediatric patients demonstrates synergistic benefit of pharmacologic and behavioral anxiety management strategies.

Written by the GCMD Library team from the infographic.

A circular diagram divided into four quadrants with a central illustration of parents holding a child during a medical procedure. The quadrants are color-coded in shades of blue, with arrows on the left side showing a downward cascade of outcomes. Study metadata appears in a light blue box on the upper left, and citation information is displayed at the bottom with institutional logos.

Infographic by Lena Bode
"ParentalPresence during induction of Anesthesia improves compliance of the child and Reduces Emergence Delirium" Gil Mayo D et.al.

Full article: pubmed.ncbi.nlm.nih.gov/34243210/

Authors: Diego Gil Mayo, Pascual Sanabria Carretero, Luis Gajate Martin, Jose Alonso Calderón, Francisco Hernández Oliveros, María Gomez Rojo

Abstract

Introduction

Preoperative stress and anxiety in pediatric patients are associated with poor compliance during induction of anesthesia and a higher incidence of postoperative maladaptive behaviors. The aim of our study was to determine which preoperative preparation strategy improves compliance of the child during induction and decreases the incidence and intensity of emergence delirium (ED) in children undergoing ambulatory pediatric surgery.

Materials and methods

This prospective observational study included 638 pediatric American Society of Anesthesiologists I-II patients who underwent ambulatory pediatric surgery, grouped into four preoperative preparation groups: NADA (not premedicated), MDZ (premedicated with midazolam), PPIA (parental presence during induction of anesthesia), and PPIA + MDZ. The results were subsequently analyzed in four age subgroups: Group 1 (0-12 months), Group 2 (13-60 months), Group 3 (61-96 months), and Group 4 (> 96 months). Preoperative anxiety (modified Yale Preoperative Anxiety Scale [m-YPAS]), compliance of the child during induction (Induction Compliance Checklist [: ICC]), and ED (Pediatric Anesthesia Emergence Delirium scale) were analyzed in each group.

Results

Eighty-one percent of patients in the PPIA + MDZ preparation group presented a perfect compliance during the induction of anesthesia (ICC = 0), less preoperative anxiety (mean score m-YPAS = 26), less probability of ED (odds ratio: 10, 5 [3-37.5]; p < 0.05), and less ED intensity compared with the NADA group (1.2 vs. 5.8; p = 0.001).

Conclusion

PPIA associated with midazolam premedication improves compliance during induction and decreases the incidence and intensity of ED.

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