Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial.

Background: Children and parents experience significant anxiety and distress during the preoperative period. Currently available interventions are having limited efficacy. Based on an integration of the literature in both the anesthesia and psychological milieus, the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole.

Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery.

Objective: Findings from published studies suggest that the postoperative recovery process is more painful, slower, and more complicated in adult patients who had high levels of preoperative anxiety. To date, no similar investigation has ever been conducted in young children.

Methods: We recruited 241 children aged 5 to 12 years scheduled to undergo elective outpatient tonsillectomy and adenoidectomy.

What pediatricians should know about child-related malpractice payments in the United States.

Objective: The purpose of this study was to examine child-related National Practitioner Data Bank data.

Methods: Data were obtained from the National Practitioner Data Bank.

Results: the period from February 1, 2004, through December 31, 2005, a total of 30195 malpractice payments were made on behalf of practitioners in the United States; 14% of those payments (4107 of 30,195 payments) were child related.

Predicting which children benefit most from parental presence during induction of anesthesia.

Background: The purpose of this large-scale prospective cohort study (n = 426) was to identify child and parent characteristics that are associated with low anxiety and good compliance during induction of anesthesia when parents are present.

Methods: Outcome variables included child's anxiety and child's compliance during induction of anesthesia. Predictor variables included demographics, temperament, trait (baseline) anxiety, coping style, and locus of control.

Psychological predictors of postoperative sleep in children undergoing outpatient surgery.

Background: The purpose of this study was to examine psychological predictors of postoperative sleep in children undergoing outpatient surgery.

Methods: We used hierarchical multivariate regression to examine the impact of demographic and personality variables such as parental worry/anxiety [NEO-personality inventory, revised (NEO-PI-R) Neuroticism], parental coping style (Miller Behavioral Style Scale), children's aggressive behavior [child behavior checklist (CBCL) externalizing], and children's temperament (emotionality, activity, sociability, and impulsivity) on postoperative sleep in 52 consecutive, healthy, children undergoing outpatient surgery. Sleep was assessed using actigraphy, a valid, reliable and objective measure of sleep quality.

Predicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach.

Using a multiply matched, concurrent cohort analysis, with 568 subjects matched from data obtained by our laboratory over the past 7 yr, we examined whether parental presence during induction of anesthesia (PPIA) reduces children's anxiety depending on the interaction between child and parent's baseline anxiety. Children's and parents' baseline anxiety was assessed preoperatively; children's anxiety was again assessed during induction of anesthesia. We found that anxious children who received PPIA from a calm parent were significantly less anxious during induction of anesthesia as compared with anxious children who did not receive PPIA (P = 0.

Preoperative psychological preparation of the child for surgery: an update.

Preoperative anxiety is associated with a number of poor postoperative outcomes and with significant parental and child distress before surgery. Preparing children for surgery can prevent many behavioral and physiologic manifestations of anxiety. Psychologic and behavioral interventions and pharmacologic interventions are available to treat preoperative anxiety in children.

Behavioral interactions in the perioperative environment: a new conceptual framework and the development of the perioperative child-adult medical procedure interaction scale.

Background: The authors suggest that research in the area of parental presence during induction of anesthesia should shift to emphasize what parents actually do during induction, rather than focusing simply on their presence. As a first step, the authors aimed to develop a behavioral coding system that would measure child and adult interactions in the perioperative environment.

Methods: The authors enrolled 45 parents and children (aged 2-12 yr) undergoing elective surgery and general anesthesia.

Motivation and maternal presence during induction of anesthesia.

Background: The authors developed a measure to determine whether maternal motivation to be present during induction (Motivation for Parental Presence during Induction of Anesthesia [MPPIA]) is related to children's anxiety during the induction process.

Methods: Mothers and children (aged 2-12 yr) undergoing outpatient, elective surgery and general anesthesia were enrolled in this study (n = 289 dyads). Items to assess motivation for parental presence during induction were selected by experts in anesthesiology, psychology, and child development; mothers completed the resulting 14-item measure as well as assessments of anxiety and coping style.

Acupressure and preoperative parental anxiety: a pilot study.

In this randomized sham-controlled study we examined the anxiolytic and sedative effects of acupressure on parents in the preoperative holding area before their children's surgery. Sixty-one parents received acupressure either at the Yintang point (midpoint between the two eyebrows) or at a sham point. Anxiety (as measured by the Stait-Trait Anxiety Inventory), arterial blood pressure, and heart rate were assessed before and after the intervention and a Bispectral Index monitor was used to continuously monitor hypnotic sedation levels.

Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey.

Objective: To identify common treatments used for low-back pain (LBP) during pregnancy.

Design: A two-part anonymous survey.

Setting/location: New Haven, Connecticut.

Sevoflurane versus halothane: postoperative maladaptive behavioral changes: a randomized, controlled trial.

Background: The authors conducted a double-blind, randomized, controlled trial to determine whether the use of sevoflurane in children undergoing anesthesia and surgery results in a higher incidence of postoperative maladaptive behavioral changes as compared with halothane.

Methods: Children and their parents (n = 102) were randomly assigned to either a halothane group (n = 50) or a sevoflurane group (n = 52). The intraoperative anesthetic protocol was strictly controlled, and the postoperative analgesic consumption and pain levels were recorded.

Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited.

Low back pain during pregnancy: prevalence, risk factors, and outcomes.

Objective: To estimate the severity of the low back pain (LBP) during pregnancy, including prevalence, risk factors, impact on daily living, and health provider management.

Methods: An anonymous survey consisting of 36 questions was distributed to pregnant women participating in various prenatal care clinics and educational classes in New Haven County, Connecticut. A total of 950 surveys was returned from May 2002 through October 2003.

Parental auricular acupuncture as an adjunct for parental presence during induction of anesthesia.

Background: The purpose of this study was to determine whether parental auricular acupuncture reduces parental preoperative anxiety and thus allows children to benefit from parental presence during induction of anesthesia.

Methods: Mothers of children who were scheduled to undergo surgery were randomly assigned to an acupuncture intervention group (auricular press needles at relaxation, tranquilizer point, and master cerebral point) or a sham acupuncture control group (auricular press needles at the shoulder, wrist, and extraneous auricular point). The intervention was performed at least 30 min before the child's induction of anesthesia.

Interactive music therapy as a treatment for preoperative anxiety in children: a randomized controlled trial.

Unlabelled: In this study, we examined whether interactive music therapy is an effective treatment for preinduction anxiety. Children undergoing outpatient surgery were randomized to 3 groups: interactive music therapy (n = 51), oral midazolam (n = 34), or control (n = 38). The primary outcome of the study was children's perioperative anxiety.

Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995-2002: results of a follow-up national survey.

Unlabelled: Both parental presence during induction of anesthesia and sedative premedication are currently used to treat preoperative anxiety in children. A survey study conducted in 1995 demonstrated that most children are taken into the operating room without the benefit of either of these two interventions. In 2002 we conducted a follow-up survey study.

Sleeping characteristics of adults undergoing outpatient elective surgery: a cohort study.

Study Objective: To describe sleeping patterns of adults before and after outpatient surgery.

Design: Observational cohort study.

Setting: Outpatient surgical facility.

The use of complementary and alternative medicines by surgical patients: a follow-up survey study.

Unlabelled: In a previous study, we indicated that 42% of surgical outpatients are interested in using acupuncture as a treatment modality for preoperative anxiety. We designed this follow-up survey to assess differences in attitude toward complementary-alternative medical therapies (CAM) between patients undergoing outpatient surgeries and those undergoing inpatient surgeries. The results indicate that most surgical patients (57.

Hemispheric synchronized sounds and intraoperative anesthetic requirements.

Hemispheric synchronization is currently promoted as a treatment for preoperative anxiety and for reduction of intraoperative anesthetic and analgesic consumption. We designed this study to examine the effect of Hemisync sounds on anesthetic hypnotic depth. After obtaining informed consent, we randomized subjects undergoing general anesthesia and outpatient surgery into two groups: the treatment group received Hemisync sounds (n = 31), and the control group received a blank cassette tape (n = 29).

Parental intervention choices for children undergoing repeated surgeries.

Unlabelled: No studies have examined parental preference for a preoperative intervention in healthy children undergoing subsequent surgeries. We collected data prospectively from 83 children who previously underwent surgery and were part of an investigation by our study group, then returned for a subsequent surgery. At the initial surgery, children were assigned (no parental intervention) to receive oral midazolam (n = 13), or parental presence during the induction of anesthesia (PPIA, n = 27), or PPIA + midazolam (n = 10) or no intervention (n = 33).

Parental presence during induction of anesthesia: physiological effects on parents.

Background: The authors conducted a randomized controlled trial to determine whether parental presence during induction of anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress.

Methods: Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPIA; (2) PPIA plus 0.5 mg/kg oral midazolam; and (3) control (no PPIA or midazolam).

Sleeping characteristics of children undergoing outpatient elective surgery.

Background: A significant number of children undergoing anesthesia and surgery exhibit new-onset sleep-related problems postoperatively. The aim of this longitudinal cohort study was to expand previous research in this area by using a new objective technology.

Methods: This study compared children undergoing general anesthesia and outpatient surgery (n = 92) to a community-based control group of children (n = 77).

Psychological preparation of the parent and pediatric surgical patient.

Some 3 million children undergo anesthesia and surgery in the United States every year; 40% to 60% of these children develop significant behavioral stress prior to surgery. Multiple interventions have been suggested to treat the preoperative behavioral stress responses in children. There is a trend toward reducing both behavioral and pharmacological preoperative interventions aimed at children, perhaps because though there is a consensus that preoperative interventions can be useful, almost no outcome studies have evaluated the effects of these interventions on measurable, clinically "important" postoperative outcomes.