Effect of Parental Presence During Induction of Anaesthesia on Preoperative Anxiety in Children Premedicated with Intranasal Midazolam: A Randomised Controlled Study

Abstract

Background
Preoperative anxiety in children hampers anaesthetic management and postoperative recovery. While both, midazolam and parental presence during induction of anaesthesia (PPIA), are established anxiolytic strategies, evidence regarding additive effect of PPIA over midazolam is limited. This study aimed to evaluate the effect of PPIA on preoperative anxiety in children premedicated with intranasal midazolam and scheduled for elective surgery under general anaesthesia (GA).
Methods
This hospital-based randomised controlled study was conducted at ABVIMS & Dr. RML Hospital, New Delhi, India from January 2021 to May 2022 and included 78 ASA 1 and 2 children, aged 4-12 years, scheduled for elective surgery under GA. Participants were administered intranasal midazolam and were randomly divided into 2 groups. In group P, one parent accompanied children inside the operation theatre (OT) until induction, whereas group A children were unaccompanied. Anxiety was assessed using modified Yale Preoperative Anxiety Scale (mYPAS) at 3 time points, T1 (preoperative area), T2 (OT table), and T3 (mask placement during induction).
Results
Intergroup comparison of mYPAS scores revealed no significant difference at any time point (Group P vs. A at T1 65.64 ± 18.29 vs. 68.68 ± 17.97, p = 0.461; T2 49.40 ± 5.59 vs. 51.78 ± 8.12, p = 0.135; T3 46.77 ± 2.69 vs. 45.98 ± 2.80, p = 0.208). However, both groups showed significant reduction in mYPAS scores over time.
Conclusions
The addition of PPIA to intranasal midazolam offers no additional benefit in reducing preoperative anxiety in children undergoing elective surgery under GA.