Parent Present Induction (PPI) Process

Before Starting Anesthesia (Induction)
The anesthesiologist must 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.