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Family-centered surgical preparation improves children's recovery after surgery.

Facing surgery can cause significant anxiety for children and their parents, but a new, family-centered, surgical behavioral preparation program is reducing children's anxiety before surgery and improving the children's recovery after surgery. The study, "Family-centered Preparation for Surgery Improves Perioperative Outcomes in Children: A Randomized Controlled Trial," details the ADVANCE program trial that took place between November 2000 and October 2004 at Yale-New Haven Children's Hospital. The article appears in the January issue of Anesthesiology, the journal of the American Society of Anesthesiologists (ASA).

To reduce anxiety and improve children's recovery after surgery, the behaviorally centered ADVANCE program targets the family as a whole and consists of several components:


Distraction on the day of surgery

Video modeling and education prior to surgery

Adding parents to the child's surgical experience and promoting family-centered care

No excessive reassurance--a suggestion made to parents for communication with children about surgery

Coaching of parents by researchers to help them succeed

Exposure/Shaping of the child via induction mask practice (the mask placed over the child's nose and mouth to deliver anesthetic drugs)

Families participating in the ADVANCE preparation experienced reduced anxiety prior to surgery for both parents and children. Children in the ADVANCE preparation were also less likely to be disoriented after surgery, were discharged from the hospital faster, and required less pain medication. "This is the first time that a preoperative behavioral intervention in children has been shown to affect both preoperative and postoperative outcomes," said study first author Zeev N. Kain, MD, MBA. "In addition to improved outcomes, ADVANCE also provides families with a new skill set that is applicable to subsequent medical procedures."

The study consisted of 408 parents and children who were undergoing general anesthesia and elective outpatient surgery. Participating families were assigned to one of four groups receiving either standard care, parental presence during start of anesthesia, ADVANCE preparation, or administration of oral midazolam (a sedative drug).

Child anxiety in the preoperative holding area and during induction of anesthesia was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS), an anxiety measure of young children made through observation. Trained observers measuring anxiety levels, behavior when awakening from anesthesia, amount of pain medication needed, and discharge time from the hospital did not know to which groups the participating families had been assigned.

Founded in 1905, the American Society of Anesthesiologists is an educational, research, and scientific association with 41,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient. Visit our website at Visit the journal Anesthesiology at
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Publication:Townsend Letter
Article Type:Report
Geographic Code:1USA
Date:Jan 1, 2008
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