Family-centered preparation for surgery improves perioperative outcomes in children - A randomized controlled trial
Family-centered preparation for surgery improves perioperative outcomes in children - A randomized controlled trial
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DOI：
10.1097/00000542-200701000-00013
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发表时间：
2007-01-01
期刊：
影响因子：
8.8
通讯作者：
Blount, Ronald L.
中科院分区：
文献类型：
--
作者：
Kain, Zeev N.;Caldwell-Andrews, Alison A.;Blount, Ronald L.
背景：儿童和父母在术前经历了严重的焦虑和痛苦。目前可用的干预措施效果有限。基于麻醉和心理环境的文献整合，作者制定了一个面向行为的围手术期准备计划，为接受手术的儿童，目标是家庭作为一个整体。方法：儿童和他们的父母（n = 408）被随机分配到四组之一：（1）控制：接受标准护理;（2）父母在场：在麻醉诱导期间接受标准父母在场;（3）ADVANCE：接受以家庭为中心的行为准备;（4）口服咪达唑仑。作者评估了分组对术前焦虑水平和术后结局（如镇痛药消耗和苏醒期谵妄）的影响。结果：与其他三组相比，ADVANCE组的父母和儿童在等候区的焦虑程度显著降低（34.4 +/- 16 vs. 39.7 +/- 15; P = 0.007），与对照组和父母在场组相比，（分别为44.9 ± 22 vs. 51.6 ± 25和53.6 ± 25; P = 0.006）。ADVANCE组和咪达唑仑组儿童麻醉诱导期间的焦虑和依从性相似（44.9 +/- 22 vs. 42.9 +/- 24; P = 0.904）。ADVANCE组的儿童术后出现谵妄的发生率较低（P = 0.038），在恢复室中需要的镇痛显著较少（P = 0.016），并提前从恢复室出院（P = 0.04）与其他三组儿童比较。以家庭为中心的术前ADVANCE准备程序可有效降低术前焦虑，改善术后结局。
Background: Children and parents experience significant anxiety and distress during the preoperative period. Currently available interventions are having limited efficacy. Based on an integration of the literature in both the anesthesia and psychological milieus, the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole.Methods: Children and their parents (n = 408) were randomly assigned to one of four groups: (1) control: received standard of care; (2) parental presence: received standard parental presence during induction of anesthesia; (3) ADVANCE: received family-centered behavioral preparation; and (4) oral midazolam. The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative Outcomes such as analgesic consumption and emergence delirium.Results: Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups (34.4 +/- 16 vs. 39.7 +/- 15; P = 0.007) and were less anxious during induction of anesthesia as compared with the control and parental presence groups (44.9 +/- 22 vs. 51.6 +/- 25 and 53.6 +/- 25, respectively; P = 0.006). Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups (44.9 +/- 22 vs. 42.9 +/- 24; P = 0.904). Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery (P = 0.038), required significantly less analgesia in the recovery room (P = 0.016), and were discharged from the recovery room earlier (P = 0.04) as compared with children in the three other groups.Conchision; The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes.