Is there a place for parents in the operating room?

Abstract

The presence of a parent in the operating room (OR) during induction of anesthesia is controversial. In order to assess the feasibility, safety, and acceptance of this practice, we evaluated a near-4-year experience with 3,086 patients less than 15 years of age, who were operated on at a free-standing ambulatory surgical center. The age distribution was: 1 to 23 months, 790; 2 to 5 years, 1,190; 6 to 10 years, 775; and 10 to 15 years, 331. The distribution of patients by service was: otorhinolaryngology, 1,597; pediatric surgery, pediatric urology, and plastic surgery, 948; ophthalmology, 443; orthopaedics, 72; and dental, 26. No premedication was employed. Anesthetic gases were delivered via a mask while the parent held or remained close to the child. Vascular access was established after the induction. Only five patients (tonsillectomy, four; circumcision, one) were admitted to the base hospital and subsequently discharged. Advantages of parental presence in the OR during anesthesia induction are decreased psychological trauma (child), smoother induction (child), and decreased parental anxiety. Possible disadvantages include disruption of OR routine, unpredictability of parental behavior, and increased time and cost. Because of careful preoperative preparation of parents by the nurses and anesthetists, the first three problems rarely occurred. The cost of supplies used by each parent was minimal. Practically all parents chose to accompany the child to the OR. The feedback during follow-up from those parents has been excellent. Nurses, anesthesiologists, and surgeons are enthusiastic about the program. In the examined setting, this approach has proven safe, simple, and effective.