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LOS ANGELES – Parents want to be with their children in the operating room during the anxious moments that precede induction of anesthesia.
And children want their parents to be present. Even anesthesiologists, surgeons, and nurses think this is a good idea.
But in a series of randomized trials in Canada, Europe, and the United States, only an expensive, multiday “Cadillac” behavioral intervention program has proved its worth in reducing child anxiety in meaningful ways when parents are present in the operating room before surgical procedures, Dr. Zeev N. Kain said at the conference.
The Advance program – which involves a psychoeducational and behavior modeling video, graduated shaping exercises, distraction techniques, supportive telephone coaching, and adherence checks – reduced emergence from anesthetics, lowered analgesic use, and reduced time to discharge (Anesthesiology 2010; 112:751-5).
“It's a great intervention. The problem is, it's an expensive intervention,” he said.
Of course, anyone who has been involved in pediatric surgery can easily point to anecdotal situations in which parental presence in the operating room was highly comforting to the child, easing induction of anesthesia, said Dr. Kain, who is professor and chair of anesthesiology and perioperative care at the University of California, Irvine.
“A randomized controlled trial is not a real-life situation [in which] you look at the child, you look at the parent, you look at yourself on that day and [decide], 'Do I think this would be beneficial at this time?'” he said.
Any systematic revision in standard operating room procedures needs to be more widely applicable to a variety of children of different ages, temperaments, and coping styles and parents with styles to match.
A moment-to-moment factor analysis of what actually happens in the operating room may shed light on where anxiety-prevention efforts have gone wrong and what needs to happen to bring calm to this and other settings for major medical procedures.
“We're not asking the right question,” said Dr. Kain in summarizing results of his previous studies. “We shouldn't ask, should we or should we not be bringing parents into the operating room? We should ask, what did the parents do in the operating room?”
Dr. Kain and his associates recently reviewed videotapes of OR encounters, painstakingly recording hundreds of variables in behavior, verbal and physical interchanges, and physiological responses.
They found that parents and health professionals alike tend to stop utilizing the most effective interventions – distraction techniques and strengthening of coping mechanisms – and start relying on unhelpful strategies once a child's anxiety begins to build.
In a study of 273 children undergoing surgical procedures, the minute-to-minute analysis showed that most were coping well while walking to the OR.
Their coping behaviors increased as caregivers and professionals engaged in distraction techniques.
“Then it's just downhill from there,” said Dr. Kain, pointing to parallel behavior graphs.
Reassurance and empathy – strategies proven to be quite unhelpful in reducing children's anxiety – were increasingly used with children as they entered the OR, were notified of what was happening, and had the mask placed on their faces for anesthesia induction.
“When we put the mask on, almost 38% of the kids started crying,” he said. Videotapes showed that parents and professionals resorted to repeatedly making statements such as, “It's going to be OK,” when the going got tough.
As a result of the sequential analysis, Dr. Kain and his associates are developing a training program in data-driven behavioral preparation techniques to reduce children's perioperative distress.
The program, which is being piloted at the University of California, Los Angeles, will help nurses and anesthesiologists anticipate and recognize signs of children's emotional suffering and teach them effective tools to intervene.
If all goes well, the study will be expanded to five hospitals in a randomized clinical trial, said Dr. Kain, who reported no relevant financial conflicts of interest.
LOS ANGELES – Parents want to be with their children in the operating room during the anxious moments that precede induction of anesthesia.
And children want their parents to be present. Even anesthesiologists, surgeons, and nurses think this is a good idea.
But in a series of randomized trials in Canada, Europe, and the United States, only an expensive, multiday “Cadillac” behavioral intervention program has proved its worth in reducing child anxiety in meaningful ways when parents are present in the operating room before surgical procedures, Dr. Zeev N. Kain said at the conference.
The Advance program – which involves a psychoeducational and behavior modeling video, graduated shaping exercises, distraction techniques, supportive telephone coaching, and adherence checks – reduced emergence from anesthetics, lowered analgesic use, and reduced time to discharge (Anesthesiology 2010; 112:751-5).
“It's a great intervention. The problem is, it's an expensive intervention,” he said.
Of course, anyone who has been involved in pediatric surgery can easily point to anecdotal situations in which parental presence in the operating room was highly comforting to the child, easing induction of anesthesia, said Dr. Kain, who is professor and chair of anesthesiology and perioperative care at the University of California, Irvine.
“A randomized controlled trial is not a real-life situation [in which] you look at the child, you look at the parent, you look at yourself on that day and [decide], 'Do I think this would be beneficial at this time?'” he said.
Any systematic revision in standard operating room procedures needs to be more widely applicable to a variety of children of different ages, temperaments, and coping styles and parents with styles to match.
A moment-to-moment factor analysis of what actually happens in the operating room may shed light on where anxiety-prevention efforts have gone wrong and what needs to happen to bring calm to this and other settings for major medical procedures.
“We're not asking the right question,” said Dr. Kain in summarizing results of his previous studies. “We shouldn't ask, should we or should we not be bringing parents into the operating room? We should ask, what did the parents do in the operating room?”
Dr. Kain and his associates recently reviewed videotapes of OR encounters, painstakingly recording hundreds of variables in behavior, verbal and physical interchanges, and physiological responses.
They found that parents and health professionals alike tend to stop utilizing the most effective interventions – distraction techniques and strengthening of coping mechanisms – and start relying on unhelpful strategies once a child's anxiety begins to build.
In a study of 273 children undergoing surgical procedures, the minute-to-minute analysis showed that most were coping well while walking to the OR.
Their coping behaviors increased as caregivers and professionals engaged in distraction techniques.
“Then it's just downhill from there,” said Dr. Kain, pointing to parallel behavior graphs.
Reassurance and empathy – strategies proven to be quite unhelpful in reducing children's anxiety – were increasingly used with children as they entered the OR, were notified of what was happening, and had the mask placed on their faces for anesthesia induction.
“When we put the mask on, almost 38% of the kids started crying,” he said. Videotapes showed that parents and professionals resorted to repeatedly making statements such as, “It's going to be OK,” when the going got tough.
As a result of the sequential analysis, Dr. Kain and his associates are developing a training program in data-driven behavioral preparation techniques to reduce children's perioperative distress.
The program, which is being piloted at the University of California, Los Angeles, will help nurses and anesthesiologists anticipate and recognize signs of children's emotional suffering and teach them effective tools to intervene.
If all goes well, the study will be expanded to five hospitals in a randomized clinical trial, said Dr. Kain, who reported no relevant financial conflicts of interest.
LOS ANGELES – Parents want to be with their children in the operating room during the anxious moments that precede induction of anesthesia.
And children want their parents to be present. Even anesthesiologists, surgeons, and nurses think this is a good idea.
But in a series of randomized trials in Canada, Europe, and the United States, only an expensive, multiday “Cadillac” behavioral intervention program has proved its worth in reducing child anxiety in meaningful ways when parents are present in the operating room before surgical procedures, Dr. Zeev N. Kain said at the conference.
The Advance program – which involves a psychoeducational and behavior modeling video, graduated shaping exercises, distraction techniques, supportive telephone coaching, and adherence checks – reduced emergence from anesthetics, lowered analgesic use, and reduced time to discharge (Anesthesiology 2010; 112:751-5).
“It's a great intervention. The problem is, it's an expensive intervention,” he said.
Of course, anyone who has been involved in pediatric surgery can easily point to anecdotal situations in which parental presence in the operating room was highly comforting to the child, easing induction of anesthesia, said Dr. Kain, who is professor and chair of anesthesiology and perioperative care at the University of California, Irvine.
“A randomized controlled trial is not a real-life situation [in which] you look at the child, you look at the parent, you look at yourself on that day and [decide], 'Do I think this would be beneficial at this time?'” he said.
Any systematic revision in standard operating room procedures needs to be more widely applicable to a variety of children of different ages, temperaments, and coping styles and parents with styles to match.
A moment-to-moment factor analysis of what actually happens in the operating room may shed light on where anxiety-prevention efforts have gone wrong and what needs to happen to bring calm to this and other settings for major medical procedures.
“We're not asking the right question,” said Dr. Kain in summarizing results of his previous studies. “We shouldn't ask, should we or should we not be bringing parents into the operating room? We should ask, what did the parents do in the operating room?”
Dr. Kain and his associates recently reviewed videotapes of OR encounters, painstakingly recording hundreds of variables in behavior, verbal and physical interchanges, and physiological responses.
They found that parents and health professionals alike tend to stop utilizing the most effective interventions – distraction techniques and strengthening of coping mechanisms – and start relying on unhelpful strategies once a child's anxiety begins to build.
In a study of 273 children undergoing surgical procedures, the minute-to-minute analysis showed that most were coping well while walking to the OR.
Their coping behaviors increased as caregivers and professionals engaged in distraction techniques.
“Then it's just downhill from there,” said Dr. Kain, pointing to parallel behavior graphs.
Reassurance and empathy – strategies proven to be quite unhelpful in reducing children's anxiety – were increasingly used with children as they entered the OR, were notified of what was happening, and had the mask placed on their faces for anesthesia induction.
“When we put the mask on, almost 38% of the kids started crying,” he said. Videotapes showed that parents and professionals resorted to repeatedly making statements such as, “It's going to be OK,” when the going got tough.
As a result of the sequential analysis, Dr. Kain and his associates are developing a training program in data-driven behavioral preparation techniques to reduce children's perioperative distress.
The program, which is being piloted at the University of California, Los Angeles, will help nurses and anesthesiologists anticipate and recognize signs of children's emotional suffering and teach them effective tools to intervene.
If all goes well, the study will be expanded to five hospitals in a randomized clinical trial, said Dr. Kain, who reported no relevant financial conflicts of interest.