Family-Centered Preparation for Surgery Improves Perioperative Outcomes in Children: A Randomized Controlled Trial
Zeev N. Kain,*†‡§ Alison A. Caldwell-Andrews,*† Linda C. Mayes,‡§ Megan E. Weinberg,* Shu-Ming Wang,*† Jill E. MaClaren,*†§ and Ronald L. Blount,∥
(Anesthesiology, 106:65-74, 2007)
*Center for Advancement of Perioperative Health and Departments of †Anesthesiology, ‡Pediatrics, and §Child Psychiatry, Yale University School of Medicine, New Haven, CT; and ∥Department of Psychology, University of Georgia, Athens, GA.
Children and parents experience significant anxiety and distress during the perioperative period, and interventions that are currently available have shown little efficacy. A behaviorally oriented perioperative preparation program for children was developed that targets the family as a whole. Children and their parents (n = 408) were randomly assigned to 1 of 4 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 effect of group assignment on perioperative anxiety levels and postoperative outcomes, such as analgesic consumption and emergence delirium, was assessed. Parents and children in the ADVANCE group showed markedly lower anxiety in the holding area compared with all 3 other groups (34.4 ± 16 vs. 39.7 ± 15) and were less anxious during induction of anesthesia compared with the control and parental presence groups (44.9 ± 22 vs. 51.6 ± 25 and 53.6 ± 25, respectively). Anxiety and compliance during induction of anesthesia were similar for children in both the ADVANCE and midazolam groups (44.9 ± 22 vs. 42.9 ± 24). Children in the ADVANCE group showed a lower incidence of emergency delirium after surgery, required markedly less analgesia in the recovery room, and were discharged from the recovery room sooner compared with children in the other 3 groups. It was concluded that the family-centered preoperative ADVANCE preparation program is effective in reducing preoperative anxiety and improving postoperative outcomes.