The Effects of Preanesthetic Parental Presence on Preoperative Anxiety of Children and their Parents: A Randomized Clinical Trial Study in Iran

Razie Rasti-Emad-Abadi, Abbas Naboureh, Morteza Nasiri, Nilofar Motamed, Faezeh Jahanpour


Introduction: Parental presence during induction of anesthesia (PPIA) has been a controversial issue, with some studies showing its effects on reducing anxiety. Hence, this study aimed to investigate the effects of PPIA on preoperative anxiety of children as well as their parents.
Materials and Methods: This clinical trial was conducted among 60 children aged 2–10 years and their parents. Children were randomly assigned to intervention (n = 30) and control (n = 30) groups. Children in the control group were taken to the operating room (OR) alone, while those in the intervention group were taken to the OR with one of their parents. When the anesthetic mask was placed on the children’s face (induction), the children’s preoperative anxiety in both groups was assessed using Modified‑Yale Preoperative Anxiety Scale (M‑YPAS), and after that the parents in the intervention group were escorted to the waiting area. Parents’ anxiety in both the groups was measured by the Spielberg State‑Trait Anxiety Inventory (STAI) in the waiting area. Data were analyzed using descriptive and inferential (independent t‑test and Chi‑square test) statistic methods through the Statistical Package for the Social Sciences version 18 software.

Results: Results showed no significant difference between children’s anxiety in the intervention (70.83) and control (70.39) groups in the preanesthetic period. In addition, no significant difference was seen between the intervention (79.23) and control (85.86) groups regarding total parents’ anxiety.

Conclusions: PPIA was not successful in reducing the children’s preoperative anxiety as well as parents’ anxiety. Future studies in this area are needed to clarify the effects of this intervention in pediatric populations.


Anesthesia; anxiety; children; parental presence; preoperative care

Full Text:



Capurso M, Ragni B. Psycho‑educational preparation of children for anaesthesia: A review of intervention methods. Patient Educ Couns 2016;99:173‑85.

Fortier MA, Del Rosario AM, Martin SR, Kain ZN. Perioperative anxiety in children. Paediatr Anaesth 2010;20:318‑22.

Banchs RJ, Lerman J. Preoperative anxiety management, emergence delirium, and postoperative behavior. Anesthesiol Clin 2014;32:1‑23.

Drasković B, Simin JM, Kvrgić IM. Psychological aspects of pediatric anesthesia. Med Pregl 2015;68:29‑34.

Litke J, Pikulska A, Wegner T. Management of perioperative stress in children and parents. Part I‑‑The preoperative period. Anaesthesiol Intensive Ther 2012;44:165‑9.

St‑Onge AR. Reducing pediatric anxiety preoperatively: Strategies for nurses. ORNAC J 2012;30:14‑9.

Manyande A, Cyna AM, Yip P, Chooi C, Middleton P. Non‑pharmacological interventions for assisting the induction of anesthesia in children. Cochrane Database Syst Rev 2015;7:CD006447.

Mainer JA. Nonpharmacological interventions for assisting the induction of anesthesia in children. AORN J 2010;92:209‑10.

Costi D, Cyna AM, Ahmed S, Stephens K, Strickland P, Ellwood J, et al. Effects of sevoflurane versus other general anesthesia on emergence agitation in children. Cochrane Database Syst Rev 2014;9:CD007084.

Lerman J. Preoperative assessment and premedication in pediatrics. Eur J Anaesthesiol 2013;30:645‑50.

Chundamala J, Wright JG, Kemp SM. An evidence‑based review of parental presence during anesthesia induction and parent/child anxiety. Can J Anaesth 2009;56:57‑70.

Scully SM. Parental presence during pediatric anesthesia induction. AORN J 2012;96:26‑33.

Machotta A. Parental presence during induction of anesthesia in children: Pros and cons. Anaesthesist 2014;63:326‑30.

Kita T, Yamamoto M. Parental presence is a useful method for smooth induction of anesthesia in children: A postoperative questionnaire survey. Masui 2009;58:719‑23.

Bailey KM, Bird SJ, McGrath PJ, Chorney JE. Preparing Parents to Be Present for Their Child’s Anesthesia Induction: A Randomized Controlled Trial. Anesth Analg 2015;121:1001‑10.

Kim H, Jung SM, Yu H, Park SJ. Video Distraction and Parental Presence for the Management of Preoperative Anxiety and Postoperative Behavioral Disturbance in Children: A Randomized Controlled Trial. Anesth Analg 2015;121:778‑84.

Kain ZN, Mayes LC, Caramico LA, Silver D, Spieker M, Nygren MM, et al. Parental presence during induction of anesthesia, A randomized controlled trial. Anesthesiology 1996;84:1060‑7.

Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstadter MB, et al. The Yale preoperative anxiety scale: How does it compare with a “gold standard”? Anesth Analg 1997;85:783‑8.

Roberts KE, Hart TA, Eastwood JD. Factor structure and validity of the State‑Trait Inventory for Cognitive and Somatic Anxiety. Psychol Assess 2016;28:134‑46.

Wright K, Stewart S. When are parents helpful? A randomized clinical trial of the efficacy of parental presence for pediatric anesthesia. Can J Anesth 2010;57:751‑8.

Akinci SB, Kose EA, Ocal T, Aypar U. The effects of maternal presence during anesthesia induction on the mother’s anxiety and changes in children’s behavior. Turk J Pediatr 2008;50:566‑71.

Kain ZN, Caldwell‑Andrews AA, Mayes LC, Wang SM, Krivutza DM, LoDolce ME. Parental presence during induction of anesthesia: Physiological effects on parents. Anesthesiology 2003;98:58‑64.

Kain ZN, Mayes LC, Caldwell‑Andrews AA, Saadat H, McClain B, Wang SM. Predicting which children benefit most from parental presence during induction of anesthesia. Paediatr Anaesth 2006;16:627‑34.

Messeri A, Caprilli S, Busoni P. Anaesthesia induction in children: A psychological evaluation of the efficiency of parents’ presence. Paediatr Anaesth 2004;14:551‑6.


  • There are currently no refbacks.