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Children who took part in a family preparation program before going to surgery were less anxious before the procedure and needed less pain medication afterward than children who didn't participate. Called ADVANCE, the program was developed to help prepare children and their parents for surgery. It included a 23-minute videotape, information for parents about preparing their kids for surgery, toys for children to play with before surgery, practice using the anesthesia mask, and a special surprise for children to open while breathing through the mask.


Researchers randomly assigned 408 children ages 2 to 12 and their parents to one of these groups:

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* standard care only


* parental presence at the start of anesthesia


* sedation with oral midazolam 30 minutes before going to the operating room


* the ADVANCE program.



Researchers assessed preoperative anxiety levels and postoperative outcomes, including delirium and the need for analgesics.


Children who took part in the ADVANCE program were significantly less anxious in the holding area before surgery than children in the other three groups. They were also less anxious during the start of anesthesia compared with the children who received standard care and those who had their parents present. Children who were given midazolam before surgery exhibited similar levels of anxiety during anesthesia induction as those in the ADVANCE program.


After surgery, children in the ADVANCE group had a lower incidence of delirium, needed significantly less analgesia, and were discharged from the recovery room earlier than children in the other three groups.


The ADVANCE program appears to be effective in managing preoperative anxiety and improving postoperative outcomes, the researchers concluded. But because the program is expensive, it may be practical only in children's hospitals.




Kain ZN, et al., Family-centered preparation for surgery improves perioperative outcomes in children: A randomized controlled trial, Anesthesiology, January 2007.