1. VonKoss Krowchuk, Heidi PhD, RN, PNP, FAAN

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In my opinion, parental presence during anesthesia induction is an important component in providing comprehensive nursing care to children and their families. Most children undergoing surgery experience significant fear, anxiety, and distress. Young children may fear the separation from their parents and become anxious because of the unfamiliar surroundings and people; older children and teens may fear the surgery itself or become anxious because they lose the ability to control themselves and their surroundings. Parents also usually experience some distress as they watch their anxious child wheeled away from the hospital room by operating room personnel.


In the not-so-distant past, children were premedicated with sedatives before their arrival at the surgical suite. This practice helped to prevent a child's anxiety associated with separation and loss of control, because the child was sedated in the presence of the parents. Unfortunately, premedication was found to be related to longer recovery times, so the practice became the exception more than the rule, particularly for children younger than 4 years of age (Kain, 2001). The practice of premedication also did little to alleviate the distress that parents experienced. What is common now in anesthesia practice is to take the unmedicated child (without a parent) into an induction area, where the child is prepared for anesthesia administration and other surgical preparations are made.


During the induction of anesthesia, it is important that the child be calm and quiet so the induction can proceed smoothly. If a child is anxious, he or she may become agitated, and agitation is associated with increased breath-holding and the risk of laryngospasm, which makes induction difficult. Other complications (reported to last for up to 6 months after surgery) are behavior problems such as sleep disturbances, nighttime crying, and eating disturbances. Temper tantrums also have been associated with less-than-smooth inductions (Munro & D'Errico, 2000). Having a parent present during the induction to reassure the child can reduce a child's anxiety, facilitate a smooth induction, and help to prevent complications. Parents also benefit from being present, because they take an active role in calming their child. Hand-holding, quietly talking or singing to the child, hair-stroking, and storytelling are activities that parents can perform to give comfort to their child while the initial anesthesia is administered.


It is important, however, that parents who choose to participate in the induction process with their child be adequately prepared for the event, and nurses should take the lead in educating the parents about the process. Sometimes the methods chosen for induction may be painful, and parents need to respond in a calming manner to their child, who may become momentarily distressed. Institutions that offer parental presence during anesthesia induction often require parents to read materials about the induction and view a videotape about the procedures to reduce parental anxiety and increase the ability of the parents to support their child through the induction (Romino, Keatley, Secrest, & Good, 2005).


Parents should be given the option to participate; some parents may not wish to be present during their child's anesthesia induction. If parents choose to be present, however, it is likely that their presence will be beneficial to their child and their overall satisfaction with the surgical experience of their child will be increased (Kain, 2001).


We expect parents to be present and take an active role in comforting their child during invasive procedures such as immunizations, lumbar punctures, and venipunctures. Family-centered care, the model predominantly used to provide care to children and their families, emphasizes the importance of involving parents in all aspects of their child's care. It just makes good nursing sense to include parents in supporting and comforting their child during anesthesia induction.




Kain, Z. (2001). Premedication and parental presence revisited. Current Opinion in Anaesthesiology, 14, 331-337. [Context Link]


Munro, H., & D'Errico, C. (2000). Parental involvement in perioperative anesthetic management. Journal of PeriAnesthesia Nursing, 15(6), 397-400. [Context Link]


Romino, S. L., Keatley, V. M., Secrest, J., & Good, K. (2005). Parental presence during anesthesia induction in children. AORN Journal, 81, 780-792. [Context Link]