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Eur J Pediatr Surg 2022; 32(04): 346-351
DOI: 10.1055/s-0041-1732321
Original Article

Parental Presence during Induction of Anesthesia Improves Compliance of the Child and Reduces Emergence Delirium

Diego Gil Mayo 
1   Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
,
Pascual Sanabria Carretero
2   Department of Pediatric Anesthesiology, Hospital Universitario La Paz and H. Quironsalud Madrid, Spain
,
Luis Gajate Martin
1   Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
,
Jose Alonso Calderón
3   Department of Pediatric Surgery, Hospital Universitario Niño Jesús and H. Quironsalud Madrid, Spain
,
Francisco Hernández Oliveros
4   Department of Pediatric Surgery, Hospital Universitario La Paz and H. Quironsalud Madrid, Spain
,
María Gomez Rojo
1   Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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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.

Keywords

emergence delirium - preoperative anxiety - induction of anesthesia


Publication History

Received: 17 February 2021

Accepted: 10 June 2021

Article published online:
09 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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