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Background: Although some anesthesiologists use oral sedatives or parental presence during induction of anesthesia (PPIA) to treat preoperative anxiety in children, others may use these interventions simultaneously (e.g., sedatives and PPIA). The purpose of this investigation was to determine whether this approach has advantages over treating children with sedatives alone., Methods: The child's and the parental anxiety throughout the perioperative period was the primary endpoint of the study. Parental satisfaction was the secondary endpoint. Subjects (n = 103) were assigned randomly to one of two groups: a sedative group (0.5 mg/kg oral midazolam) or a sedative and PPIA group. Using standardized measures of anxiety and satisfaction, the effects of the interventions on the children and parents were assessed. Statistical analysis (varimax rotation) of the satisfaction questionnaire items resulted in two factors that described satisfaction of the separation process and satisfaction of the overall care provided., Results: Anxiety in the holding area, at entrance to the operating room, and at introduction of the anesthesia mask did not differ significantly between the two groups (F[2,192] = 1.26, P = 0.28). Parental anxiety after separation, however, was significantly lower in the sedative and PPIA group (F[2,93] = 4.46, P = 0.037). Parental satisfaction with the overall care provided (-0.28 +/- 1.2 vs. 0.43 +/- 0.26, P = 0.046) and with the separation process (-0.30 +/- 1.2 vs. 0.47 +/- 0.20, P = 0.03) was significantly higher among the sedative and PPIA group compared with the sedative group., Conclusions: PPIA in addition to 0.5 mg/kg oral midazolam has no additive effects in terms of reducing a child's anxiety. Parents who accompanied their children to the operating room, however, were less anxious and more satisfied.

Unlabelled: We determined whether children who are extremely anxious during the induction of anesthesia are more at risk of developing postoperative negative behavioral changes compared with children who appear calm during the induction process. Children (n = 91) aged 1-7 yr scheduled for general anesthesia and elective outpatient surgery were recruited. Using validated measures of preoperative anxiety and postoperative behaviors, children were evaluated during the induction of general anesthesia and on Postoperative Days 1, 2, 3, 7, and 14. Using a multivariate logistic regression model, in which the dependent variable was the presence or absence of postoperative negative behavioral changes and the independent variables included several potential predictors, we demonstrated that anxiety of the child, time after surgery, and type of surgical procedure were predictors for postoperative maladaptive behavior. The frequency of negative postoperative behavioral changes decreased with time after surgery, and the frequency of negative postoperative behavioral changes increased when the child exhibited increased anxiety during the induction of anesthesia. Finally, we found a significant correlation (r) of 0.42 (P = 0.004) between the anxiety of the child during induction and the excitement score on arrival to the postanesthesia care unit. We conclude that children who are anxious during the induction of anesthesia have an increased likelihood of developing postoperative negative behavioral changes. We recommend that anesthesiologists advise parents of children who are anxious during the induction of anesthesia of the increased likelihood that their children will develop postoperative negative behavioral changes such as nightmares, separation anxiety, and aggression toward authority., Implications: Anesthesiologists who care for children who are anxious during the induction of anesthesia should inform parents that these children have an increased likelihood of developing postoperative negative behavioral changes.

Background: Both midazolam and parental presence during induction of anesthesia are routinely used to treat preoperative anxiety in children. The purpose of this investigation was to determine which of these two interventions is more effective., Methods: Anxiety of the child during the perioperative period was the primary end point. Secondary end points included anxiety of the parent and compliance of the child during induction. Children (n = 88) were randomly assigned to one of three groups: (1) 0.5 mg/kg oral midazolam; (2) parental presence during induction of anesthesia; or (3) control (no parental presence or premedication). Using multiple behavioral measures of anxiety, the effect of the intervention on the children and their parents was assessed., Results: Observed anxiety in the holding area (T1), entrance to the operating room (T2), and introduction of the anesthesia mask (T3) differed significantly among the three groups (P = 0.032). Post hoc analysis indicated that children in the midazolam group exhibited significantly less anxiety compared with the children in the parental-presence group or control group (P = 0.0171). Similarly, parental anxiety scores after separation were significantly less in the midazolam group compared with the parental-presence or control groups (P = 0.048). The percentage of inductions in which compliance of the child was poor was significantly greater in the control group compared with the parental-presence and midazolam groups (25% vs. 17% vs. 0%, P = 0.013)., Conclusions: Under the conditions of this study, oral midazolam is more effective than either parental presence or no intervention for managing a child's and parent's anxiety during the preoperative period.

Study Objective: To identify which perioperative information outpatients want from their anesthesiologist., Design: Cross-sectional study., Setting: Outpatient center., Patients: 197 ASA physical status I and II patients undergoing outpatient surgery., Interventions: A questionnaire examining for "desire for information"., Measurements and Main Results: Demographic data including age, ethnicity, gender, socioeconomic status, and history of previous surgery were obtained. Trait, situational anxiety, and coping strategy were assessed using a validated behavioral instrument and a questionnaire adopted from previous studies conducted in Australia, Scotland, and Canada. Each questionnaire contained 14 statements regarding specific perioperative details. An index of the overall patient desire for information (PDI) was calculated for each subject. More than 85% of subjects gave a high priority to being informed for all the 14 items. Scores on the overall index were found to be higher for females than for males (32 +/- 6 vs. 30 +/- 6; p = 0.03), and this finding persisted in a multivariable model that also included coping strategies and anxiety (DF = 1,175, F = 4.6, p = 0.01). Subjects also had higher PDI scores if a first degree relative had a history of previous surgery (33 +/- 5 vs. 31 +/- 6; p = 0.007). On analysis of individual questionnaire items, Latino Americans were significantly less likely than European Americans or African Americans to desire perioperative information (p < 0.05). Similarly, females had a significantly higher desire for information than males. Subjects who were divorced demonstrated a higher desire for information than did single or married subjects., Conclusions: Ethnicity, gender, coping mechanism, marital status, and a history of previous surgery in a relative have been identified as predictors for the desire for information.

The purpose of this investigation was to identify the perioperative anesthetic information parents want from the anesthesiologist, and to determine whether the provision of detailed anesthetic risk information is associated with increased parental anxiety. The investigation consisted of a cross-sectional study followed by a randomized controlled trial. In Phase 1, baseline and situational anxiety, coping strategy, and temperament were obtained from parents of children undergoing surgery (n = 334). A questionnaire examining the desire for perioperative information was administered to all parents. In Phase 2, 47 parents were randomly assigned to receive either routine anesthetic risk information (control) or detailed anesthetic risk information (intervention). The effect of the intervention on parental anxiety was assessed over four time points: prior to the intervention, immediately after the intervention, day of surgery in the holding area, and at separation to the operating room. For Phase 1, the majority of parents (> 95%) preferred to have comprehensive information concerning their child's perioperative period, including information about all possible complications. For selected items, increased parental educational level was associated with increased desire for information (P < 0.05). For Phase 2, when the intervention group was compared with the control group, there were no significant differences in parental anxiety over the four time points [F(1,45) = 0.6, P = 0.4]. Also, the interaction between time and group assignment was not significant [F(3,135) = 1.66, P = 0.18]. We conclude that parents of children undergoing surgery desire comprehensive perioperative information. Moreover, when provided with highly detailed anesthetic risk information, the parental anxiety level did not increase.