Children's preoperative stress according to the parental presence evaluated by salivary cortisol and mYPAS: quasi-randomized trial.
Ketillyn Nayara de Macedo Silveira, Rodrigo Leal Alves, Paulo do Nascimento Júnior and 3 others
PMID 38466906WHAT IT FOUND
Salivary cortisol did not differ between groups.
Children whose parents were present at anesthesia induction had higher observed anxiety scores than children whose parents waited outside.
Key findings
01Children with parental presence at induction had higher mYPAS anxiety scores than children without parental presence (median 55.0 vs 37.5; p = 0.044).
02Salivary cortisol levels did not differ significantly between accompanied and unaccompanied children (p = 0.258).
03Parental salivary cortisol correlated with children's mYPAS scores (r = 0.396; p = 0.022) and with parent HADS depression scores (r = 0.345; p = 0.049).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-center study at one hospital, with no separate preoperative room for children and parents. Group allocation was based on parent preference, not randomization, so parents of anxious children may have been more likely to accompany. No postoperative follow-up, so the study cannot describe how anxiety or cortisol related to recovery. Child age and ASA physical status were not analyzed as influences on stress, and few children were ASA III. Salivary cortisol varies widely between and within people, making it hard to interpret as a stress biomarker. Secondary analyses were exploratory, without power calculation or correction for multiple comparisons. The stated inclusion age range of 5 to 12 years did not match the reported mean ages in months (44 and 36 months).
Declared interests
Financial support was provided in part by CAPES, Finance Code 001. No other conflicts of interest are stated.
The easy way to misread this
Do not conclude that parental presence causes higher child anxiety or that it should be prohibited. Parents selected the group, and the cortisol outcome was null, so this paper does not prove a causal effect of presence.