Press releases

Released February 17, 1998
Yale-New Haven Hospital news release

Study Shows Its Takes More Than Hugs
To Calm Kids Before Surgery

Premedication Reduces Child's Anxiety; Eases Post-Operative Recovery

For more information, call 203-688-2488 or E-mail Ken Best

A new study presented at the annual meeting of the Society for Pediatric Anesthesia in Phoenix, Ariz., shows that while nothing takes the place of a parent's tender loving care, it may not be enough to ease a child's fears and anxiety before surgery. The study is the first to demonstrate the anxiety-reducing benefits of a sedative versus parental presence prior to the administration of general anesthesia for surgery.

"Pediatric surgery does not have to be a frightening experience for young children," said Dr. Zeev N. Kain, lead study investigator and director of pediatric anesthesia, Yale University School of Medicine; and medical director, Pediatric Surgery Center, Yale-New Haven Children's Hospital. "These results show that premedication is of significant clinical benefit in reducing the traumatic experience of childhood anesthesia and surgery."

Dr. Kain's study, conducted at the Yale-New Haven Children's Hospital, looked at 85 children, ages one to six, who received general anesthesia and surgery. The trial investigated the effects of premedicating the patients with the short-acting sedative, VERSED^® (midazolam), on preoperative anxiety. Dr. Kain's study found that the vast majority, 90 percent, of children who were premedicated in the pre-operative holding area showed significantly less anxiety when being separated from parents and entering the operating room, than those children who received only parental comforting. In the trial, children were administered VERSED^® and, approximately 15 minutes later, were brought into the operating room. The study found that premedication was associated with significantly fewer compliance problems during placement of the anesthesia mask, compared with the control group.

"My six-year-old daughter Emilie was clearly nervous and visibly upset about her double-hernia repair surgery," said Jennie Murphy of Southport whose daughter participated in the trial. "As a mother, my first reaction was to stay with Emilie through the whole surgery, but she really responded well to the sedative she received just before the anesthesia. She was relaxed and giggling, and was not at all apprehensive at the time of separation. The premedication allowed me to comfort Emilie until it was time for the procedure, and made it easier for all of us when we were separated."

VERSED^® is indicated for use as a pre-operative sedative, anxiety-reducing and amnesia-producing agent prior to procedures in emergency rooms and during many other medical procedures, as well as in general surgery. The drug received market clearance last year as the first sedative for use in newborns, infants and children of all ages in critical care settings.

"This study demonstrates that premedication prior to surgery is a more effective intervention than parental presence during induction of anesthesia for managing a child's anxiety during separation and induction," said Dr. Kain. "Anesthesiologists should incorporate its use in surgical cases to ease both the child's and parent's anxiety, and to help ensure better behavioral outcome."

In earlier research, Dr. Kain demonstrated that children who are medicated with VERSED^® before surgery exhibited significantly fewer post-operative behavior problems. By contrast, test subjects who were not premedicated displayed more negative behavior after surgery, including aggression toward authority, apathy/withdrawal, sleep disturbances and bedwetting. Another study by Dr. Kain found that agitation during the induction of general anesthesia was associated with behavioral problems immediately after surgery, such as withdrawal, aggression, temper tantrums, nightmares, and refusal to eat.

"Emilie had no drastic behavioral changes following her surgery," added Murphy. "Overall, she had a very positive experience."

Each year, approximately one and a half million children under age 15 have surgery, according to the National Center for Health Statistics. Dr. Kain offers the following advice to help ease parents' worries about their child's surgery:

• Explain to the child why he/she is having surgery in clear, simple terms
• If offered, participate in the hospital's preadmission tour with the child
• On the day of surgery, meet with the physician and anesthesiologist to ask questions about the surgical procedure and available medications

For parents with children facing surgery, a free brochure, Rest Assured, is available through anesthesiologists to help prepare for the child's medical procedure.

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