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Zeev N Kain - One of the best experts on this subject based on the ideXlab platform.

  • predicting which children benefit most from parental presence during Induction of Anesthesia
    Pediatric Anesthesia, 2006
    Co-Authors: Zeev N Kain, Linda C. Mayes, Alison A Caldwellandrews, Haleh Saadat, Brenda C Mcclain, Shu-ming Wang
    Abstract:

    BACKGROUND The purpose of this large-scale prospective cohort study (n = 426) was to identify child and parent characteristics that are associated with low anxiety and good compliance during Induction of Anesthesia when parents are present. METHODS Outcome variables included child's anxiety and child's compliance during Induction of Anesthesia. Predictor variables included demographics, temperament, trait (baseline) anxiety, coping style, and locus of control. RESULTS Results of a linear regression model (overall proportion of variance accounted for equals 39.5%) showed that significant predictors of anxiety during Induction of Anesthesia while parents are present included: the child's age (DeltaR(2) = 0.315, P = 0.0001), behavior during previous medical visits (DeltaR(2) = 0.025, P = 0.001), child's activity level (DeltaR(2) = 0.016, P = 0.007), parent's state (contextual) anxiety (DeltaR(2) = 0.022, P = 0.001) and parent's locus of control (DeltaR(2) = 0.009, P = 0.036). A linear regression model that was constructed with compliance of the child as the outcome revealed similar findings. CONCLUSIONS Children who benefit from parental presence are older, had lower levels of activity in their temperament, and had parents who were calmer and who valued preparation and coping skills for medical situations. The practical implications of these findings are discussed.

  • predicting which child parent pair will benefit from parental presence during Induction of Anesthesia a decision making approach
    Anesthesia & Analgesia, 2006
    Co-Authors: Zeev N Kain, Inna Maranets, Alison A Caldwellandrews, William Nelson, Linda C. Mayes
    Abstract:

    Using a multiply matched, concurrent cohort analysis, with 568 subjects matched from data obtained by our laboratory over the past 7 yr, we examined whether parental presence during Induction of Anesthesia (PPIA) reduces children's anxiety depending on the interaction between child and parent's baseline anxiety. Children's and parents' baseline anxiety was assessed preoperatively; children's anxiety was again assessed during Induction of Anesthesia. We found that anxious children who received PPIA from a calm parent were significantly less anxious during Induction of Anesthesia as compared with anxious children who did not receive PPIA (P = 0.03). In contrast, calm children who received PPIA from an overly anxious parent were significantly more anxious as compared with calm children who were not accompanied by a parent (P = 0.002). We found no effect of PPIA on children's anxiety during Induction of Anesthesia when calm parents accompanied calm children into the operating room (P = 0.15) or when overly anxious parents accompanied anxious children (P = 0.49). We conclude that the presence of a calm parent does benefit an anxious child during Induction of Anesthesia and the presence of an overly anxious parent has no benefit.

  • Parental Auricular Acupuncture as an Adjunct for Parental Presence during Induction of Anesthesia
    Anesthesiology, 2004
    Co-Authors: Shu-ming Wang, Inna Maranets, Megan E. Weinberg, Alison A. Caldwell-andrews, Zeev N Kain
    Abstract:

    BACKGROUND: The purpose of this study was to determine whether parental auricular acupuncture reduces parental preoperative anxiety and thus allows children to benefit from parental presence during Induction of Anesthesia. METHODS: Mothers of children who were scheduled to undergo surgery were randomly assigned to an acupuncture intervention group (auricular press needles at relaxation, tranquilizer point, and master cerebral point) or a sham acupuncture control group (auricular press needles at the shoulder, wrist, and extraneous auricular point). The intervention was performed at least 30 min before the child's Induction of Anesthesia. All mothers were present during Induction of Anesthesia. The behavioral and physiologic anxiety of mothers and children were rated during the perioperative process. RESULTS: : Multivariable analysis examining maternal anxiety as a function of group found a group-by-time interaction (F1,65 = 4.1, P = 0.04). That is, after Induction, maternal anxiety in the acupuncture group was significantly lower (42.9 +/- 10 vs. 49.5 +/- 11; P = 0.014). A multivariate model (F1,65 = 4.8, P =0.031) also showed that children whose mothers received the acupuncture intervention were significantly less anxious on entrance to the operating room (34.9 +/- 20 vs. 47.4 +/- 26; P = 0.03) and during introduction of the Anesthesia mask (38.6 +/- 25 vs. 55.6 +/- 31; P = 0.016). There were no significant differences in maternal blood pressure and heart rate between the two groups. CONCLUSIONS: : Auricular acupuncture significantly decreased maternal anxiety during the preoperative period. Children of mothers who underwent acupuncture intervention benefitted from the reduction of maternal anxiety during the Induction of Anesthesia.

  • trends in the practice of parental presence during Induction of Anesthesia and the use of preoperative sedative premedication in the united states 1995 2002 results of a follow up national survey
    Anesthesia & Analgesia, 2004
    Co-Authors: Zeev N Kain, Shu-ming Wang, Megan E. Weinberg, Dawn M. Krivutza, Alison A Caldwellandrews, Dorothy Gaal
    Abstract:

    Both parental presence during Induction of Anesthesia and sedative premedication are currently used to treat preoperative anxiety in children. A survey study conducted in 1995 demonstrated that most children are taken into the operating room without the benefit of either of these two interventions. In 2002 we conducted a follow-up survey study. Five thousand questionnaires were mailed to randomly selected physician members of the American Society of Anesthesiologists. Mailings were followed by a nonresponse bias assessment. Twenty-seven percent (n = 1362) returned the questionnaire after 3 mailings. We found that a significantly larger proportion of young children undergoing surgery in the United States were reported to receive sedative premedication in 2002 as compared with 1995 (50% vs 30%, P = 0.001). We also found that in 2002 there was significantly less geographical variability in the use of sedative premedication as compared with the 1995 survey (F = 8.31, P = 0.006). Similarly, we found that in 2002 parents of children undergoing surgery in the United States were allowed to be present more often during Induction of Anesthesia as compared with 1995 (χ2 = 26.3, P = 0.0001). Finally, similar to our findings in the 1995 survey, midazolam was uniformly selected most often to premedicate patients before surgery.

  • parental presence during Induction of Anesthesia physiological effects on parents
    Anesthesiology, 2003
    Co-Authors: Zeev N Kain, Shu-ming Wang, Linda C. Mayes, Dawn M. Krivutza, Alison A Caldwellandrews, Megan E Lodolce
    Abstract:

    Background: The authors conducted a randomized controlled trial to determine whether parental presence during Induction of Anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress. Methods: Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPIA; (2) PPIA plus 0.5 mg/kg oral midazolam; and (3) control (no PPIA or midazolam). The effect of the group assignment on parental heart rate (HR), parental blood pressure, and parental skin conductance level (SCL) were assessed. Both parental HR and parental SCL were monitored continually. Anxiety of the parent and child was also assessed. Results: Parental HR increased from baseline until the Induction of Anesthesia (P = 0.001). A group-by-time effect (P = 0.005) was also found. That is, throughout the Induction period there were several time points at which parents in the two PPIA groups had a significantly higher HR than did parents in the control group (P < 0.05). Similarly, SCL was found to increase in all parents from baseline until Induction of Anesthesia (P = 0.001). Significant group differences in SCL changes over time were found as well (P = 0.009). State anxiety and blood pressure following Induction of Anesthesia did not differ significantly between groups (P = nonsignificant). Examination of parental Holter data revealed no rhythm abnormalities and no electrocardiogram changes indicating ischemia. Conclusions: The authors found that PPIA is associated with increased parental HR and SCL. However, no increased incidence of electrocardiogram abnormalities were found in parents present during Induction of Anesthesia.

Linda C. Mayes - One of the best experts on this subject based on the ideXlab platform.

  • predicting which children benefit most from parental presence during Induction of Anesthesia
    Pediatric Anesthesia, 2006
    Co-Authors: Zeev N Kain, Linda C. Mayes, Alison A Caldwellandrews, Haleh Saadat, Brenda C Mcclain, Shu-ming Wang
    Abstract:

    BACKGROUND The purpose of this large-scale prospective cohort study (n = 426) was to identify child and parent characteristics that are associated with low anxiety and good compliance during Induction of Anesthesia when parents are present. METHODS Outcome variables included child's anxiety and child's compliance during Induction of Anesthesia. Predictor variables included demographics, temperament, trait (baseline) anxiety, coping style, and locus of control. RESULTS Results of a linear regression model (overall proportion of variance accounted for equals 39.5%) showed that significant predictors of anxiety during Induction of Anesthesia while parents are present included: the child's age (DeltaR(2) = 0.315, P = 0.0001), behavior during previous medical visits (DeltaR(2) = 0.025, P = 0.001), child's activity level (DeltaR(2) = 0.016, P = 0.007), parent's state (contextual) anxiety (DeltaR(2) = 0.022, P = 0.001) and parent's locus of control (DeltaR(2) = 0.009, P = 0.036). A linear regression model that was constructed with compliance of the child as the outcome revealed similar findings. CONCLUSIONS Children who benefit from parental presence are older, had lower levels of activity in their temperament, and had parents who were calmer and who valued preparation and coping skills for medical situations. The practical implications of these findings are discussed.

  • predicting which child parent pair will benefit from parental presence during Induction of Anesthesia a decision making approach
    Anesthesia & Analgesia, 2006
    Co-Authors: Zeev N Kain, Inna Maranets, Alison A Caldwellandrews, William Nelson, Linda C. Mayes
    Abstract:

    Using a multiply matched, concurrent cohort analysis, with 568 subjects matched from data obtained by our laboratory over the past 7 yr, we examined whether parental presence during Induction of Anesthesia (PPIA) reduces children's anxiety depending on the interaction between child and parent's baseline anxiety. Children's and parents' baseline anxiety was assessed preoperatively; children's anxiety was again assessed during Induction of Anesthesia. We found that anxious children who received PPIA from a calm parent were significantly less anxious during Induction of Anesthesia as compared with anxious children who did not receive PPIA (P = 0.03). In contrast, calm children who received PPIA from an overly anxious parent were significantly more anxious as compared with calm children who were not accompanied by a parent (P = 0.002). We found no effect of PPIA on children's anxiety during Induction of Anesthesia when calm parents accompanied calm children into the operating room (P = 0.15) or when overly anxious parents accompanied anxious children (P = 0.49). We conclude that the presence of a calm parent does benefit an anxious child during Induction of Anesthesia and the presence of an overly anxious parent has no benefit.

  • parental presence during Induction of Anesthesia physiological effects on parents
    Anesthesiology, 2003
    Co-Authors: Zeev N Kain, Shu-ming Wang, Linda C. Mayes, Dawn M. Krivutza, Alison A Caldwellandrews, Megan E Lodolce
    Abstract:

    Background: The authors conducted a randomized controlled trial to determine whether parental presence during Induction of Anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress. Methods: Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPIA; (2) PPIA plus 0.5 mg/kg oral midazolam; and (3) control (no PPIA or midazolam). The effect of the group assignment on parental heart rate (HR), parental blood pressure, and parental skin conductance level (SCL) were assessed. Both parental HR and parental SCL were monitored continually. Anxiety of the parent and child was also assessed. Results: Parental HR increased from baseline until the Induction of Anesthesia (P = 0.001). A group-by-time effect (P = 0.005) was also found. That is, throughout the Induction period there were several time points at which parents in the two PPIA groups had a significantly higher HR than did parents in the control group (P < 0.05). Similarly, SCL was found to increase in all parents from baseline until Induction of Anesthesia (P = 0.001). Significant group differences in SCL changes over time were found as well (P = 0.009). State anxiety and blood pressure following Induction of Anesthesia did not differ significantly between groups (P = nonsignificant). Examination of parental Holter data revealed no rhythm abnormalities and no electrocardiogram changes indicating ischemia. Conclusions: The authors found that PPIA is associated with increased parental HR and SCL. However, no increased incidence of electrocardiogram abnormalities were found in parents present during Induction of Anesthesia.

  • Sensory stimuli and anxiety in children undergoing surgery: a randomized, controlled trial.
    Anesthesia & Analgesia, 2001
    Co-Authors: Zeev N Kain, Shu-ming Wang, Linda C. Mayes, Dawn M. Krivutza, Barbara A. Teague
    Abstract:

    UNLABELLED: We assessed the effectiveness of a behavioral intervention aimed at reducing the anxiety of children undergoing Anesthesia and surgery. The intervention consisted of dimmed operating room (OR) lights (200 Lx) and soft background music (Bach's "Air on a G String," 50-60 dB). Only one person, the attending anesthesiologist, interacted with the child during the Induction of Anesthesia. Children undergoing Anesthesia and surgery were randomly assigned either to a low sensory stimulation group (LSSG, n = 33) or to control group (n = 37). By using validated behavioral measures of anxiety (mYPAS) and compliance (ICC), children were evaluated at the preoperative holding area and during the Induction of Anesthesia. On postoperative Days 1, 2, 3, 7, and 14, the behavioral recovery of the children was assessed by using the Post Hospitalization Behavior Questionnaire. We found that the LSSG was significantly less anxious compared with the control group on entrance to the OR (P = 0.03) and on the introduction of the Anesthesia mask (P = 0.003). Also, the compliance during the Induction of Anesthesia was significantly better in children assigned to the LSSG (P = 0.02). The incidence of postoperative behavioral changes, however, did not differ significantly between the two groups (P = ns). We conclude that children who are exposed to low-level sensory stimuli during the Induction of Anesthesia and who are exposed to background music exhibit lower levels of anxiety and increased compliance. IMPLICATIONS: Children are less anxious and show increased compliance during Induction when exposed to a single care-provider in a dimmed, quiet operating room with background music.

  • distress during the Induction of Anesthesia and postoperative behavioral outcomes
    Anesthesia & Analgesia, 1999
    Co-Authors: Zeev N Kain, Shu-ming Wang, Linda C. Mayes, Lisa A Caramico, Maura B Hofstadter
    Abstract:

    We determined whether children who are extremely anxious during the Induction of Anesthesia are more at risk of developing postoperative negative behavioral changes compared with children who appear calm during the Induction process.Children (n = 91) aged 1-7 yr scheduled for general Anesthesia and

Ronald D Miller - One of the best experts on this subject based on the ideXlab platform.

Lisa A Caramico - One of the best experts on this subject based on the ideXlab platform.

Stephan Marsch - One of the best experts on this subject based on the ideXlab platform.

  • rocuronium versus succinylcholine for rapid sequence Induction of Anesthesia and endotracheal intubation a prospective randomized trial in emergent cases
    Anesthesia & Analgesia, 2005
    Co-Authors: Mathias Sluga, Wolfgang Ummenhofer, Wolfgang Studer, Martin Siegemund, Stephan Marsch
    Abstract:

    When Anesthesia is induced with propofol in elective cases, endotracheal intubation conditions are not different between succinylcholine and rocuronium approximately 60 s after the injection of the neuromuscular relaxant. In the present study, we investigated whether, in emergent cases, endotracheal intubation conditions obtained at the actual moment of intubation under succinylcholine differ from those obtained 60 s after the injection of rocuronium. One-hundred-eighty adult patients requiring rapid sequence Induction of Anesthesia for emergent surgery received propofol (1.5 mg/kg) and either rocuronium (0.6 mg/kg; endotracheal intubation 60 s after injection) or succinylcholine (1 mg/kg; endotracheal intubation as soon as possible). The time from beginning of the Induction until completion of the intubation was shorter after the administration of succinylcholine than after rocuronium (median time 95 s versus 130 s; P < 0.0001). Endotracheal intubation conditions, rated with a 9-point scale, were better after succinylcholine administration than after rocuronium (8.6 +/- 1.1 versus 8.0 +/- 1.5; P < 0.001). There was no significant difference in patients with poor intubation conditions (7 versus 12) or in patients with failed first intubation attempt (4 versus 5) between the groups. We conclude that during rapid sequence Induction of Anesthesia in emergent cases, succinylcholine allows for a more rapid endotracheal intubation sequence and creates superior intubation conditions compared with rocuronium.