Causes of Nitrous Oxide Contamination in Operating Rooms

the child’s distress. It may be that effective methods of training can be developed for parental presence during induction of anesthesia. Therefore, in our center, we do not offer parental presence to all patients, but rather respond to each request based on the individual child, parent, and anesthesiologist. We agree that separation anxiety is a major problem after surgery in children. This postoperative separation anxiety, however, is reflective of the behavioral response of the child to the entire perioperative experience and not only to the preoperative separation period. Therefore, to conclude that by preventing preoperative separation we will in fact prevent postoperative separation problems may be premature. Moreover, in two previous randomized controlled trials involving parental presence, we followed-up children for 2 weeks after surgery, measuring postoperative behavior with the Post Hospitalization Behavior Questionnaire. We demonstrated that children whose parents were present during induction of anesthesia were equally as likely to develop postoperative separation anxiety as children who were not accompanied by a parent. Therefore, we must deduce, based on the scientific data, that parental presence during induction of anesthesia does not decrease the incidence of postoperative behavioral changes in general, and postoperative separation anxiety in particular. In conclusion, we believe that parental presence during induction of anesthesia may have a place in a child’s perioperative experience, but significant work is needed to determine what role parents should play and how best to prepare parents to be most helpful to their children in the operating room setting. As it stands, parental presence increases parental satisfaction but does not affect a child’s immediate perioperative anxiety or long-term behavior.