Presence of Family Members in the Operating Room: Is This Really Helpful?
A 3-year-old boy presents to the ambulatory surgery unit of a large city hospital for a bilateral tonsillectomy and adenoidectomy for mild sleep apnea and snoring. He was born full term with no other medical history. While discussing the anesthetic plan f
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Michelle N. Gonta and Misuzu Kameyama
Case A 3-year-old boy presents to the ambulatory surgery unit of a large city hospital for a bilateral tonsillectomy and adenoidectomy for mild sleep apnea and snoring. He was born full term with no other medical history. While discussing the anesthetic plan for inhalational induction using a mask, the child’s mother interrupts and states that she heard from friends of hers that she would be able to stay with her child while he went to sleep. The child seems uncomfortable with your presence and clings to his mother’s leg. You feel that it would be appropriate for the mother to accompany her child to the operating room given the child’s clear discomfort with strangers; however, your supervising anesthesiologist, who comes from an institution that never allows parents in the operating room, does not agree.
Question Is the presence of family members in the operating room really helpful in easing the child’s anxiety? PRO Given the child’s anxiety, there is clearly an advantage to allowing the parent to be present for induction. There is a significant negative correlation [1] between age and anxiety. Children who are younger are much more anxious during induction of anesthesia than older children. In this particular study, the mean age for the most anxiety was 2.6 years old, so this child is of the appropriate age to receive the most benefit.
M.N. Gonta (&) M. Kameyama Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Medical Center, 550 First Avenue, TH530, New York, NY 10016, USA e-mail: [email protected] M. Kameyama e-mail: [email protected]
CON It’s true that younger children experience more anxiety, but often this is a result of the anxiety of their parents. Children of calm parents are less anxious during induction of anesthesia, whether the parent is present or not. Children of anxious parents were more anxious when their parent was present during induction. Another randomized controlled trial [2] found that serum cortisol was decreased in children aged >4 with a parent with a low anxiety level. These were the only children found to benefit strongly from parental presence during induction of anesthesia. Further, this study found that children aged
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