Over five million children undergo surgery in the US each year and it is reported that up to 50 percent of these children develop significant fear prior to surgery. As a result, about 20 percent of children who undergo surgery are subsequently forcefully restrained while crying, kicking and screaming throughout the induction of anesthesia process. Preoperative sedatives and parental presence during induction of anesthesia (PPIA) are available at the current time to help children during this extremely stressful period. However, preoperative sedatives, although effective, are associated with significant increases in operational costs; thus, many hospitals actively discourage their routine use. As a result, PPIA is currently used to a varying degree by about 50 percent of all anesthesiologists in the US. Interestingly, whereas initial observational studies suggested that PPIA reduces children's anxiety, recent randomized trials indicate that PPIA is not reliably beneficial. All PPIA research to date, however, only deals with one question - whether or not parents should be present in the or during induction of anesthesia. It is our opinion that the question we need to address is not that of parental presence or absence, but rather what parents actually do while in the OR. In fact, previous preliminary investigations involving children with cancer who underwent painful procedures indicate that parental and health care provider behaviors significantly influence children's anxiety during painful procedures. It is because PPIA as practiced today is ineffective, and because the use of PPIA is on the rise, that we call for the development of an intervention that will convert parental presence in the OR into an effective, clinically applicable, low-cost modality that reduces anxiety and improves postoperative outcomes. To convert PPIA into an effective intervention, however, it is of utmost importance to first empirically identify the specific parent and health-care personnel behaviors that increase or decrease children's anxiety during induction of anesthesia and the postoperative period. This will be achieved by obtaining a preoperative sequential process-oriented view of parent-child-health care provider behavioral interaction and by using robust sequential analysis techniques. As the next step we will develop data-driven behavioral preparation programs that will train parents, nurses, anesthesiologists and surgeons in how to reduce children's distress during the preoperative process.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
7R01HD048935-04
Application #
7437335
Study Section
Special Emphasis Panel (ZRG1-RPHB-J (03))
Program Officer
Haverkos, Lynne
Project Start
2008-06-01
Project End
2010-05-31
Budget Start
2008-06-01
Budget End
2009-05-31
Support Year
4
Fiscal Year
2008
Total Cost
$409,732
Indirect Cost
Name
University of California Irvine
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
046705849
City
Irvine
State
CA
Country
United States
Zip Code
92697
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Stevenson, Robert S; Rosales, Alvina; Fortier, Michelle A et al. (2017) The Role of Ethnicity and Acculturation in Preoperative Distress in Parents of Children Undergoing Surgery. J Immigr Minor Health 19:738-744
Rancourt, Kate M; Chorney, Jill M; Kain, Zeev (2015) Children's Immediate Postoperative Distress and Mothers' and Fathers' Touch Behaviors. J Pediatr Psychol 40:1115-23
Kain, Zeev N; Hwang, Jason; Warner, Mark A (2015) Disruptive Innovation and the Specialty of Anesthesiology: the Case for the Perioperative Surgical Home. Anesth Analg 120:1155-7
Jenkins, Brooke N; Kain, Zeev N; Kaplan, Sherrie H et al. (2015) Revisiting a measure of child postoperative recovery: development of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery. Paediatr Anaesth 25:738-45
Jenkins, Brooke N; Fortier, Michelle A; Kaplan, Sherrie H et al. (2014) Development of a short version of the modified Yale Preoperative Anxiety Scale. Anesth Analg 119:643-50
Chorney, Jill MacLaren; Tan, Edwin T; Kain, Zeev N (2013) Adult-child interactions in the postanesthesia care unit: behavior matters. Anesthesiology 118:834-41
Martin, Sarah R; Chorney, Jill M; Cohen, Lindsey L et al. (2013) Sequential analysis of mothers' and fathers' reassurance and children's postoperative distress. J Pediatr Psychol 38:1121-9
Chorney, Jill Maclaren; Tan, Edwin T; Martin, Sarah R et al. (2012) Children's behavior in the postanesthesia care unit: the development of the Child Behavior Coding System-PACU (CBCS-P). J Pediatr Psychol 37:338-47
Martin, Sarah R; Chorney, Jill Maclaren; Tan, Edwin T et al. (2011) Changing healthcare providers' behavior during pediatric inductions with an empirically based intervention. Anesthesiology 115:18-27

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