Shih Michael C, Elvis Phillip R, Nguyen Shaun A, Brennan Emily, Clemmens Clarice S
Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC.
Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC.
J Perianesth Nurs. 2023 Feb;38(1):12-20. doi: 10.1016/j.jopan.2022.03.008. Epub 2022 Jul 25.
Perioperative anxiety can significantly alter outcomes for pediatric patients. Parental presence at induction of anesthesia (PPIA) is one method of anxiety reduction, but the efficacy remains unclear. This systematic review and meta-analysis aimed to determine if PPIA affects child and caretaker perioperative anxiety levels.
Systematic Review and Meta-analysis METHODS: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of PubMed, Scopus, CINAHL, PsycINFO, and Cochrane Library databases was performed on June 29, 2021. Search terms were related to parental presence in the operating room, anesthesia or anesthesia induction, and pediatric patients. The literature search identified English-language studies comparing children receiving PPIA to controls or studies examining attitudes toward PPIA.
A total of 21 articles (n = 9573) met inclusion criteria. Seven studies (n = 776) quantified child anxiety with validated scales, and seven studies quantified parent anxiety (n = 621). There was no significant difference in preoperative anxiety between PPIA and controls for patients (P = .27) or caretakers (P = .99). PPIA patients had 8.40 [0.16, 16.64] (P = .05) lower Modified Yale Preoperative Anxiety Scale scores compared to control at induction, and parents had 3.41 [0.32, 6.50] (P = .03) lower State-Trait Anxiety Inventory State scores. Three studies concluded that PPIA did not increase operating room time or induction time. Twenty-three studies examined parental attitudes toward PPIA and found that 98.03% [96.09%, 99.32%] of parents present at induction would like to be present at subsequent surgeries. Contention in support for PPIA was seen amongst healthcare providers, but attitudes increasingly favored PPIA after implementation.
PPIA reduces parental and patient anxiety, may increase parental satisfaction, and may not impede operating room efficiency. PPIA should be considered as a valuable tool to improve surgical outcomes and patient and family satisfaction.
围手术期焦虑会显著改变儿科患者的治疗结果。麻醉诱导期家长陪伴（PPIA）是减轻焦虑的一种方法，但其效果仍不明确。本系统评价和荟萃分析旨在确定PPIA是否会影响儿童和看护者围手术期的焦虑水平。
系统评价和荟萃分析
本研究遵循系统评价和荟萃分析的首选报告项目指南。于2021年6月29日对PubMed、Scopus、CINAHL、PsycINFO和Cochrane图书馆数据库进行了全面的文献检索。检索词与手术室中的家长陪伴、麻醉或麻醉诱导以及儿科患者有关。文献检索确定了将接受PPIA的儿童与对照组进行比较的英文研究，或研究对PPIA态度的研究。
共有21篇文章（n = 9573）符合纳入标准。七项研究（n = 776）使用经过验证的量表对儿童焦虑进行了量化，七项研究对家长焦虑进行了量化（n = 621）。PPIA组与对照组患者术前焦虑（P = 0.27）或看护者术前焦虑（P = 0.99）无显著差异。与诱导时的对照组相比，PPIA组患者的改良耶鲁术前焦虑量表评分低8.40[0.16，16.64]（P = 0.05），家长的状态-特质焦虑量表状态评分低3.41[0.32，6.50]（P = 0.03）。三项研究得出结论，PPIA不会增加手术室时间或诱导时间。23项研究调查了家长对PPIA的态度，发现98.03%[96.09%，99.32%]的诱导期在场家长希望在后续手术中继续陪伴。医疗服务提供者对PPIA存在支持争议，但实施后态度越来越倾向于PPIA。
PPIA可减轻家长和患者的焦虑，可能提高家长满意度，且可能不会妨碍手术室效率。PPIA应被视为改善手术结果以及患者和家属满意度的一项有价值的工具。
