This Month in Anesthesiology

To further explore controversies surrounding parental presence and children’s anxiety during anesthesia induction, Caldwell-Andrews et al. devised and tested a measure to examine parents’ motivation to be present during the induction process: Motivation for Parental Presence during Induction of Anesthesia (MPPIA). The team then used the newly created measure to determine if the level of parent motivation plays any significant role in children’s anxiety during anesthesia induction. Mothers recruited for this study completed the MPPIA, as well as the State-Trait Anxiety Inventory, the Miller Behavioral Style Scale, the modified Yale Preoperative Anxiety Scale, and a Visual Analog Scale of Desire to Enter the OR, on the day of their child’s surgery. A total of 289 mother– child pairs were enrolled in the study, and an additional 25 mothers participated in the pilot portion of the study to help create the MPPIA. The children ranged in age between 2 and 12 yr and were to undergo outpatient, elective surgery and general anesthesia. Changes in the children’s anxiety levels and compliance with providers were examined from the holding area to the operating room. As anticipated, children’s anxiety increased significantly as they progressed from the preoperative holding area to the operating room and then to introduction of the anesthesia mask. Younger children were generally more anxious than older children. Analysis of the measure’s four component subscales (desire, hesitancy, anxiety, and preparation) revealed that mothers with high desire and low hesitancy (as seen on MPPIA) had children with higher anxiety during induction, compared with children of mothers who had scores of low desire and hesitancy on the MPPIA scales. The authors also found that mothers who were highly motivated reported significantly higher levels of anxiety. They conclude that clinicians need to be aware that many mothers with a high desire to be present in the operating room are very anxious, and that this trait may influence their child’s level of anxiety during induction.