Family-centered program eases surgery for kids

NEW YORK (Reuters Health) - Children who participated in a family preparation program before undergoing surgery were less anxious beforehand and required less pain medication after the operation, researchers found.

The children were also less likely to experience delirium when waking up from anesthesia and left the recovery room sooner, Dr. Zeev N. Kain of Yale University School of Medicine in New Haven, Connecticut and colleagues report.

Pre-surgery anxiety among pediatric patients increases the risk that they will suffer pain and other problems after surgery, Kain and his team note in the journal Anesthesiology. While a variety of surgery preparation programs are offered to pediatric patients and their parents, they add, there is little information on the effectiveness of these treatments.

In the current study, the researchers tested the effectiveness of ADVANCE, a multi-part family-centered program they developed to help prepare children and their parents for surgery. The program includes a 23-minute videotape; instruction and coaching for parents on how to prepare their children for surgery and to distract them while awaiting surgery; special toys for children to play with while waiting for surgery; practice in using an anesthesia mask; and a special "surprise box" for children to open as they are breathing through the anesthesia mask.

Prior to surgery, researchers randomized 408 children aged 2 to 12 to the ADVANCE program; a control group; a parental presence group, meaning parents were present during anesthesia induction; or a group receiving an oral sedative (midazolam) 30 minutes before going to the operating room.

Anxiety levels during anesthesia induction were similar in the ADVANCE and midazolam group, and lower than in both the control and parental presence groups, the researchers found. Parents in the ADVANCE group were less anxious before and after the induction of anesthesia than parents in the other three groups.

Just 10 percent of children in the ADVANCE group suffered delirium as they awoke from anesthesia, compared to 24 percent of children in the control group, 21 percent of children in the midazolam group, and 16 percent of those in the parental presence group.

Children in the ADVANCE group also consumed half as much of the painkilling drug fentanyl compared to kids in the parental presence group, and about one third as much as those in the control and midazolam groups.

Children who underwent the ADVANCE preparation also left the recovery room 20 minutes earlier than those who were given midazolam, 10 minutes earlier than children in the control group, and 13 minutes earlier than children in the parental presence group.

While the program was effective, Kain and colleagues admit it is expensive and may only be practical for use in major children's hospitals. They call for additional research on ADVANCE's costs and benefits

SOURCE: Anesthesiology, January 2007.