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Br J Anaesth. May 2011; 106(5): 713–718.
Published online Feb 14, 2011. doi:  10.1093/bja/aer010
PMCID: PMC3077749
Analysing a family-centred preoperative intervention programme: a dismantling approach
M. A. Fortier,1,4* R. L. Blount,6 S.-M. Wang,7 L. C. Mayes,8,9,10 and Z. N. Kain1,2,3,5
1Department of Anesthesiology and Perioperative Care,
2Department of Pediatrics, and
3Department of Psychiatry and Human Behavior, University of California-Irvine, 333 City Blvd West, Suite 2150, Orange, CA 92868, USA
4Department of Pediatric Psychology, and
5Department of Pediatrics, CHOC Children's Hospital, 505 S. Main St., Suite 940, Orange, CA 92868, USA
6Department of Psychology, University of Georgia, Athens, Georgia, USA
7Department of Anesthesiology, Yale University, New Haven, Connecticut, USA
8Department of Pediatrics, and
9Department of Psychology, Yale University, New Haven, Connecticut, USA
10Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
*Corresponding author. E-mail: mfortier/at/
Accepted December 3, 2010.
The goal of this project was to identify key effective components of ADVANCE, a family-centred preoperative intervention programme, through the use of a dismantling approach. ADVANCE was previously demonstrated to be more effective than parental presence and just as effective as midazolam in reducing children's preoperative anxiety. The total programme, however, may be difficult to implement in hospitals across the country.
Subjects in this follow-up dismantling report were 96 children aged 2–10 who were part of the original study and who underwent anaesthesia and surgery. Baseline characteristics, parental adherence to the components of ADVANCE, and child and parent anxiety were assessed.
We found that greater parental adherence to the ADVANCE intervention was associated with lower child anxiety before surgery. The two components of ADVANCE that emerged as having a significant impact on children's anxiety were practising with the anaesthesia mask at home and parental planning and use of distraction in the preoperative holding area. In fact, not only did children experience significantly less preoperative anxiety when their parents were adherent to mask practise and use of distraction, their anxiety tended to remain stable and relatively low throughout the preoperative period.
Shaping and exposure (i.e. practise with the anaesthesia mask) and parental use of distraction in the surgical setting are two beneficial components that could be included in preoperative preparation programmes that will be designed in the future.
Keywords: children, surgery, paediatric, surgery, preoperative period
Articles from BJA: British Journal of Anaesthesia are provided here courtesy of
Oxford University Press