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Probably most paediatricians would opt for parents being present at the induction of anaesthesia. Nevertheless the issue is not as clear cut as some might think; some children may be more anxious with parents present and some anaesthetists find it unnerving. A randomised trial at Yale University (Anesthesiology 1996;84:1060-7) showed no difference in behavioural response with parents present or absent but serum cortisols were lower in the presence of the parents in three cirucumstances; when the child was over 4 years, when the child was shy or inhibited, and when the parents showed low anxiety levels. Younger children tended to have a higher serum cortisol with parents there. This study involved a single paediatric anaesthetist at a tertiary centre; all the children took part in a preoperative programme of information, explanation, and acclimatisation and none was given premedication. The results may not be relevant to other groups of children. No mention is made in this report of parents who refused to take part in the trial. There must surely have been such parents and their absence from the trial could have influenced the results. That the presence of parents is necessarily beneficial can not be taken to be self evident. Each case is different and dependent on the child, the parents, and the anaesthetist. Nevertheless a parent friendly bias on the part of hospital staff can be no bad thing.
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