Parents in the OR
At Boston Children's Hospital, we allow a parent to be present at the start of anesthesia when the anesthesiologist considers it to be beneficial for the child. This is called a Parent Present Induction (PPI). A formal program in existence since 1989, PPI helps prepare a parent who accompanies his or her child during the start of anesthesia.
There are a variety of medications that may be given in the preoperative (Pre-Op) holding area while the child's parent(s) is present. These medications help eliminate the distress of separation at the beginning of anesthesia. When these preoperative medications are inadequate or are not recommended, a parent may go with a child into the operating room for the start of anesthesia.
The decision to offer a PPI is individualized, and is made by evaluating factors like the child's age, developmental stage, emotional status, degree of anxiety and willingness to cooperate. Children less than 1 year of age do not usually require parental presence.
At the time of the preoperative evaluation, the anesthesiologist makes an assessment of the child and parents to determine their ability to participate in a PPI in the operating room. This decision process is very important as its goal is to prevent an undesirable situation. For example, a parent who is very anxious or frightened may have difficulty providing the psychological support needed during the start of anesthesia.
If a PPI is chosen, the anesthesiologist will discuss the plan for induction with you and your child. Since no one form of induction is suitable for every child, a backup plan will be made. Parental teaching will also be provided by nurses who explain the role of the parent to his or her child in the operating room, and how the child may react and look during the induction process.
Commonly asked questions about parents in the operating room:
Why can't both parents accompany a child into the operating room for the start of anesthesia?
Although both parents provide support for their child, we have learned that it is easier for a child to focus on one parent at the start of anesthesia. During the induction process, we encourage the parent to talk to and comfort the child as he or she would at home. It can become confusing for the child to have more than one parent talking to him or her at the same time. In addition, we can safely focus our teaching and support on one parent.
If I am not the legal parent, may I still participate in the Parent Present Induction program?
The most appropriate person to accompany the child is the one who will be able to provide the necessary support to the child. This selection is individualized and does not have to be the legal parent.
What are the criteria for choosing a parent to accompany a child?
The parent should be healthy, have a calming influence on the child and must feel comfortable with his or her role in the operating room.
Do I have to accompany my child into the operating room?
No. There is no form of induction that is suitable for every child, and there are medications that can be given in the patient preparation area decrease the child's anxiety. Many children who are informed and prepared for surgery may not experience fear and anxiety.
Why can't I accompany my child if I am pregnant?
We are unable to protect pregnant women from anesthetic medications during an inhalation (mask) induction, and we prefer to avoid unecessary exposure.
Will I have to wear special clothes?
You will be asked to put on a one piece coverall (a jumpsuit that fits over your street clothes), a hat and a mask. Because the attire is strange, it can be frightening for a child. We encourage parents to put the jumpsuit on in front of the child and then reassure the child that you will only be dressed like this for a short period of time.
If my child cries, does that mean the start of anesthesia was bad?
Children cry for many reasons: when they are sleepy, hungry, in pain or upset, for example. It also depends upon the child's stage of development. Some children, especially preschoolers, will cry when the mask is first introduced or when they notice a change in the environment. The operating room staff members consider this normal and sometimes even expect it.
What if my child becomes uncooperative upon arrival in the operating room?
A backup plan is always made during the preoperative evaluation. Your child's anesthesiologist will discuss this plan with you before starting a Parent Present Induction.
When do I leave the operating room?
The anesthesiologist determines when the parent should leave the operating room. The anesthesia induction process is quick, and parents are escorted from the operating room to the Family Waiting Room by a member of the operating room staff at that time.
For more information, please call the Pre-Op Clinic at 617-355-3765.