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Parental presence: Indications

Parental presence during the induction of anesthesia has been suggested as an alternative to sedative premedication. Potential benefits include reduced need for preoperative sedation, reduced anxiety, and increased compliance during induction of anesthesia.

Common objections for parental presence include delays in operating room schedule, crowded operating rooms, adverse parental reactions during induction, and distraction of the anesthesiologist.

A national survey published in 2004 indicated that there is a large variability in hospital policy in the United States regarding parental presence. 32% of the hospitals allow parental presence, 11% encourage parental presence, 23% have no formal policy, and 26% do not allow it. A survey of anesthesiologists reported that only 10% of anesthesiologists have parents present during induction of anesthesia in more than 75% of cases and 27% of anesthesiologists have parents present in less than 25% of cases. Half (50%) of the anesthesiologist never have parents present during induction.(1)

One study in 1983 suggested that it might lower the anxiety of the child.(2) This study was nonrandomized, did not control for confounding variables, and lacked outcome measurements. Several studies have since concluded that parental presence did not result in decreased anxiety during induction of anesthesia.(3,4,5,6) The one exception is when a calm parent accompanies an anxious child to the operating room.(7) Parental presence was shown to be less effective than oral midazolam administered 30 minutes before surgery.(4)


  1. Zeev N Kain, Alison A Caldwell-Andrews, Dawn M Krivutza, Megan E Weinberg, Shu-Ming Wang, Dorothy Gaal 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. Anesth. Analg.: 2004, 98(5);1252-9, table of contents Link
  2. R S Hannallah, J K Rosales Experience with parents’ presence during anaesthesia induction in children. Can Anaesth Soc J: 1983, 30(3 Pt 1);286-9 Link
  3. Z N Kain Postoperative maladaptive behavioral changes in children: incidence, risks factors and interventions. Acta Anaesthesiol Belg: 2000, 51(4);217-26 Link
  4. Z N Kain, L C Mayes, S M Wang, L A Caramico, M B Hofstadter Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective? Anesthesiology: 1998, 89(5);1147-56; discussion 9A-10A Link
  5. Z N Kain, L C Mayes, S M Wang, L A Caramico, D M Krivutza, M B Hofstadter Parental presence and a sedative premedicant for children undergoing surgery: a hierarchical study. Anesthesiology: 2000, 92(4);939-46 Link
  6. Z N Kain, L C Mayes, L A Caramico, D Silver, M Spieker, M M Nygren, G Anderson, S Rimar Parental presence during induction of anesthesia. A randomized controlled trial. Anesthesiology: 1996, 84(5);1060-7 Link
  7. Zeev N Kain, Alison A Caldwell-Andrews, Inna Maranets, William Nelson, Linda C Mayes Predicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach. Anesth. Analg.: 2006, 102(1);81-4 Link