Differential Utilization of Parental Presence and Premedication for Induction of Anesthesia in Pediatric Patients

Abstract

PurposeKnown disparities exist in pain treatment between African American, Latino, and White children, and a recent study described ‘adultification’ of Black children, with Black children being less likely to have a parent present at induction of anesthesia and less likely to receive an anxiolytic premedication before proceeding to the operating room. The aim of this study is to identify differences based on race and socioeconomic status when treating children and their families for anesthetic induction. We hypothesize that differences exist such that certain populations are less likely to receive sedative premedication and less likely to have parents present at induction of anesthesia. DesignThis retrospective cohort study utilized demographic data along with types of surgical procedure, type of anesthesia induction, use of premedication, and involvement of child life services (including the plan for parental presence at induction) were obtained for all pediatric patients presenting for anesthetics from February 2019-March 2020. MethodsStatistical analysis consisted of fitting logistic mixed effects models for caregiver presence or for midazolam use during induction, with fixed effects for sex, race, ethnicity, language, public/private insurance, and anesthetic risk, and with provider as a random effect. FindingsA total of 7753 patients were included in our statistical analyses, Parental presence focused on 4102 patients with documentation from child life specialists (Figure 2). Females were less likely than males to have parents present at induction (OR 0.77, CI [0.67, 0.89]). When looking at race, American Indian/Alaskan Native patients (OR 0.23 [CI 0.093, 0.47]) and Black/African American patients OR 0.64 [CI 0.47, 0.89]) were less likely to have a parent present induction than White patients. Patients with private insurance were more likely to have parents present than patients with public insurance (OR 0.63 CI [0.5, 0.78]). These findings held true in age separated sensitivity analysis. For midazolam usage, Asian patients were less likely to receive this premedication (OR 0.65 CI [0.49, 0.86]). ConclusionsThis study supports previous work showing differential use of parental presence at induction based on race. Additionally, it also shows different treatment based on sex and public insurance status, a surrogate for socioeconomic status.