Opinions regarding induction with parents

CRNA, DNSc · Jul 23, 2004

The pediatric practice question posted by user69, brought up an excellent question.
Does anyone bring the parents into the room for induction? What are you opinions regarding this practice?
In the hopsital I am training at, this is almost never done. I agree with this practice. I think most parents bring added stress to the environment, definetly for the most of the health care team and very possibly for the child. I agree with jwk, adequate pre-med is the key.
I believe almost all children should receive Versed, if not for the anxiolysis, then definetly for the amnesia.
Opinions?

At our institution it is the normal practice and is very well accepted. The parent (only 1) is accompanied by a nurse liason from the preop area and she hussles the parent out of the room as soon as the child is asleep. The MD and CRNA (and SRNA) concentrate solely on the child.

jwk · Jul 23, 2004

At our institution it is the normal practice and is very well accepted. The parent (only 1) is accompanied by a nurse liason from the preop area and she hussles the parent out of the room as soon as the child is asleep. The MD and CRNA (and SRNA) concentrate solely on the child.

As stated in the other thread - I prefer parents NOT to come to the OR with their child. It's much more for the parent's peace of mind than the child. Parents can be a distraction from taking care of the child. I'd much rather concentrate on the patient, not the parent. Adequate premed is the key.

That being said - my group generally allows it. I don't like it, but I don't make the rules. However, the group at the pediatric hospital near us prohibits parents from coming to the OR with their child, a practice I wish we followed.

loisane · Jul 23, 2004

I too, have done it both ways. I'm with jwk, it can be done, but doesn't seem worth the hassle to me.

Where I am now it is the philosophy to use parents INSTEAD of premed. Since it is outpatient, time to recovery and street readiness is the primary motivator of everything we do . Well after safety....well maybe along with safety-----;-)

So the belief is that preop versed would keep the child in recovery longer. I don't particularly buy it, but people there are pretty firm in their beliefs, so ya go with the flow.

Like DNSc, we also have a dedicated person to "supervise" the parent, and they are wisked out the moment the child goes unconscious. One thing I can say, this practice is much easier now that we have sevo. A halothane induction is much harder on everyone, including the observing parent.

loisane crna

Trauma Columnist · Jul 23, 2004

Although I don't work in OR - our hospital is very family oriented and we allow family presence during codes (including peds) and also during anesthesia induction. As someone else mentioned - we ALWAYS have a dedicated RN to be with the parents and explain everything. We have nothing but positive comments.

zrmorgan · Jul 23, 2004

I would hope that policies that are generated would always prioritize the comfort level and discretion of the anesthetist. I don't think I would have a problem including a parent in on induction, however, I would be disappointed if it was an expectation, or felt that this was a right.

camay1221_RN · Jul 23, 2004

Two of my three children had tubes put in their ears, and both were given Versed before going to the OR. I was not allowed, nor did I ask, to go to the OR with either of my children. The Versed was wonderful! I didn't find that it lengthened their time in recovery either.

athomas91 · Jul 23, 2004

i haven't had parents in the room yet - and i won't likely adopt the practice...even the CRNA's i work with do not go into the room when their child is being induced - their view on it is - there is no closer thing to death and it is not easy or comforting to see...but if an institution were to have it as policy then i feel the "liason" is a must.

NCgirl · Jul 24, 2004

I also have not started my offiicial peds rotations, but this is essentially the main topic of my Capstone project. My official title is "Decreasing Perioperative Anxiety in Children", but my main focus is PPIA. Or, parental presence at induction. This is much more widely accepted in Britain; it is rare for a parent to NOT be present at induction there. It is met with some resistance here in the US, as is pretty much any new practice. Some facilities have been at this for years though. Ideally, it is used in place of preop Versed, to cut back on emergence deleriums. PPIA really serves no purpose if the kid is already sedated and won't even remember mom being there. PPIA is most effective when parent and child have been part of a preoperative preparation program, and everyone knows their role. And yes, a liason from Child Life or something of that sort is of neccessity. A well run PPIA program employs fulltime staff members to run their "orientations", as well as function as liasons. This is seen most often in ODS, when avoidance of extra drugs is desirable. PPIA is not always the answer; we all know there are parents out there who are just too high strung to be of benefit. But I think it does have it's proper place, if the time is taken to plan and implement an effective program. Part of my Capstone is actually how to start a PPIA program at a facility. Since I'm going to be doing a ridiculous amount of research on this in the next 16 months, I'd be happy to answer any questions along the way-if I can--no promises :)

jwk · Jul 24, 2004

I also have not started my offiicial peds rotations, but this is essentially the main topic of my Capstone project. My official title is "Decreasing Perioperative Anxiety in Children", but my main focus is PPIA. Or, parental presence at induction. This is much more widely accepted in Britain; it is rare for a parent to NOT be present at induction there. It is met with some resistance here in the US, as is pretty much any new practice. Some facilities have been at this for years though. Ideally, it is used in place of preop Versed, to cut back on emergence deleriums. PPIA really serves no purpose if the kid is already sedated and won't even remember mom being there. PPIA is most effective when parent and child have been part of a preoperative preparation program, and everyone knows their role. And yes, a liason from Child Life or something of that sort is of neccessity. A well run PPIA program employs fulltime staff members to run their "orientations", as well as function as liasons. This is seen most often in ODS, when avoidance of extra drugs is desirable. PPIA is not always the answer; we all know there are parents out there who are just too high strung to be of benefit. But I think it does have it's proper place, if the time is taken to plan and implement an effective program. Part of my Capstone is actually how to start a PPIA program at a facility. Since I'm going to be doing a ridiculous amount of research on this in the next 16 months, I'd be happy to answer any questions along the way-if I can--no promises :)

Full-time paid staff members to orient parents for two minutes of induction time in the OR? That sounds like an expensive luxury for these cost-cutting times.

And although I don't do many peds anymore, I don't see any significant emergence delirium in our patient population when they are given Versed. On the contrary, I've seen a lot more kids a little wild waking up when they haven't had any Versed. I also don't believe giving Versed delays discharge from the PACU.

This is all personal opinion and bias - not trying to knock anyone else's techniques. I've been doing this 23 years with several thousand kiddie anesthetics, have seen it done both ways, and I like the Versed/no parent in the room concept the best.:)

NCgirl · Jul 24, 2004

The reason hospitals can, or rather choose to, pay for staff to run a PPIA program, is because it draws business. The literature shows that most parents would rather be with their child at induction, so if you have two hospitals in town, and only one allows PPIA......well, there's the answer. I can't say how I personally feel about this yet, like I said I haven't done my peds rotations. I just feel that there's always room for improvement, and that the research shows PPIA is advantageous is certain cases.

eph432girl · Jul 24, 2004

I am all for vitamin V!!! My little girl (6y old) had dental surg. (crowns) last summer and they gave her oral Versed prior to taking her back to the OR. We were with her in the preop holding area (translation - I changed her into her gown, held her hand, sang songs, and helped her go potty) before anesthesia came for anes. visit. She did great! Meds worked in less than 10 minuntes. She remembered nothing. IV was started after she was sedated (no recall of that either).

Sometimes, I hate to draw blood from kids or start their IVs because parents are so up-tight. :angryfire I know they are worried about their little ones, but they allow that fear to manifest as hostility and ugliness and it sometimes gets in the way of us giving the kids the best care we capable of ... because MOMA BEAR is breathing down your neck.

Isn't that why the kids go to the "treatment room" for IVs? (that is how our hospital does it on the peds floor).

I just don't think it's a good idea for "most" parents to be present during induction. It's too hard, emotionally, on the parents, more stress on the anesthesia team, interruption to OR flow, very expensive liason staff like jwk mentioned, and essentially not necessary.

Sometimes, it's the PARENTS who need the Versed more than the kids do :chuckle

Tossing in another $0.02,

Christine