Click here to watch a video
on Parent Present Induction. - 7 minutes
ACH is Dedicated to the Goal of Improving Children's Lives
Arkansas Children's Hospital is among the few pediatric hospitals that offer
a formal PPI (Parent Present Induction) program. PPI is used to reduce stress
and anxiety in children who are going to receive an anesthetic. A parent who
wishes to be present with the child when he or she goes to sleep (induction)
may do so if the child meets certain criteria and the anesthesiologist agrees.
Patients who are undergoing emergency surgery or who are extremely ill may not
be eligible. In all cases the decision of the Anesthesiologist is final.
Is Parent Present Induction (PPI) For You?
There are many important things that the anesthesiologist must consider when
deciding whether or not to offer PPI. Below are some of the key points:
Parent/Caregiver
How comfortable are you with the idea of watching your child "go under
anesthesia?" Children respond directly to the emotions of their parents.
If you do not feel that you can remain calm and relaxed during the induction
process PPI is not the right choice for you.
Do you have medical conditions that may interfere with your participation? Are
you pregnant or allergic to latex products?
How does your child cope with procedures when you are present? Some children
cope better with procedures when their parent is present,
others cope better when their parent is absent. This is an individual choice.
The anesthesiologist must also consider the condition of your child. The safety
of your child is our first concern. Remember your child must be NPO
(no food or drink) for several hours before surgery as explained by your doctors
and nurses.
How old is the child? Children between the ages of 1 – 10 benefit
the most from PPI; however, arrangements can be made for some older children
and young adults.
Does your child have a special airway, heart, or lung problem?
Starting Anesthesia (Induction)
Anesthesia induction can be started in a number of ways:
Inhalation through mask
Intravenous medicine (IV)
Intra-muscular injection (IM)
Many children receive a special medicine before induction to help calm them.
This "premed" or "goofy juice" is not always used, and with
PPI may not be necessary because you will stay with your child until they are
asleep. Most children who have a PPI will breathe medicine through a special
mask; however, it is sometimes necessary to use one of the other two forms of
induction (IV or IM).
What to Expect During Mask Induction
If you are able to come with your child for the induction, there are two stages
of behavior you will see:
Stage One
During this stage the child is aware of what is happening around them. It is
normal for children to become anxious during induction.
They may try to:
push the mask away
cough or gag
cry or scream
complain about the smell
breathe rapidly, irregularly, or say that he/she cannot breathe
Some children who experience these behaviors may require gentle restraint to
complete the induction process.
Stage Two
In the second stage of the induction, children become unaware and are unlikely
to remember the events that take place or their behaviors.
Your child may:
try to sit up or stand
appear combative with the staff
say things you don’t understand
have glassy, unfocused, or rolled back eyes
become very limp
The anesthesiologist will let you know when it is time for you to leave the
induction or operating room. Your child may not appear to be asleep when you
leave the room because his or her eyes may still be partially open. It is important
for you to realize that your child is unaware of your presence or your leaving
at this point.
You can do whatever you normally do at home when helping to soothe him/her
Depending on your child’s age, you may be able to hold or rock your
child
You can hold your child’s hand
You can caress your child’s hair or face
You can talk or sing to your child
If comfortable doing so, you may be able to help hold the mask to his/her
face
Remember, it is important to remain calm
Important Things You Must Remember
If you are asked to leave the room you must do so quickly and immediately.
The medical staff must be able to focus their attention on your child
Once the anesthesia induction begins to take place, the procedures must
continue. Therefore, if your child becomes upset or resists the mask, he/she
may
have to be gently restrained.
You must be flexible! Your child’s anesthetic induction plan may need
to be changed.
Your child may need an injection or to have an IV placed if the anesthesiologist
feels it would be best at that time.
If your child is given anesthetic through his or her IV, the medicine may
sting a little as it is given.
The child may need the anesthesiologist to help with his/her breathing.
This is normal and is expected.
Time may pass differently when you are in the induction room. What may seem
like a very long period of time is likely only a few minutes.
Finally, we would like to remind you that we would never require you to choose
PPI. We understand that this is an individual choice and if you do not feel
comfortable or prepared to go back to the induction with your child we will
not ask you to do so. Our caring staff is dedicated to providing your child
with the highest quality of care whether or not you are present for your child’s
induction.
We in the Department of Anesthesiology hope that this information will be useful
to you during your child’s surgery. Should you have further questions,
please feel free to contact us at: (501) 364-1329.
