Parental involvement for pediatric perioperative anxiety: A systematic review and implementation framework

Table 1 Characteristics of included randomized trials

Ref.	Country	Design	Population	Surgical setting/procedure as reported	Comparator/intervention	Main outcomes
Yarımoglu et al[19], 2026	Turkey	RCT	80 children, 5-12 years	Elective adenotonsillectomy	Both parents vs one preferred parent	mYPAS, STAI, PAED
Matava et al[18], 2024	Canada	Pilot 2 × 2 factorial RCT	41 dyads, 1.5-12 years	Elective pediatric surgery under general anesthesia	Virtual vs physical presence, with/without coaching	mYPAS, STAI, PAED, ICC
Jain et al[27], 2023	India	Randomized comparative study	60 children, 4-12 years	Elective surgery under general anesthesia; mixed pediatric procedures	PPIA vs intravenous midazolam	mYPAS, STAI
Ismail and Mahrous[28], 2022	Egypt	RCT	120 children, 3-8 years	Elective surgery under general anesthesia; mixed pediatric procedures	Active participation vs presence only	mYPAS, PAED, parental anxiety
Yao et al[29], 2022	China	RCT	124 children, 2-6 years	Tonsillectomy and/or adenoidectomy	Control vs PPIA vs dexmedetomidine vs PPIA + dexmedetomidine	mYPAS, STAI, PAED, ICC, VAS
Rasti-Emad-Abadi et al[30], 2017	Iran	Randomized clinical trial	60 children, 2-10 years	Elective surgery under general anesthesia; mixed pediatric procedures	PPIA vs no parental presence	mYPAS, STAI
Sadeghi et al[31], 2017	Iran	Randomized clinical trial	96 children, 4-10 years	Elective minor surgery	Midazolam + PPIA vs midazolam alone	mYPAS, STAI, ICC, satisfaction
Vagnoli et al[32], 2010	Italy	Randomized prospective study	75 children, 5-12 years	Elective pediatric surgery under general anesthesia; mixed procedures	PPIA + clown vs PPIA + midazolam vs PPIA alone	mYPAS, STAI
Wright et al[17], 2010	Canada	Randomized clinical trial	61 children, 3-6 years	Outpatient pediatric surgery	PPIA vs parental absence	mYPAS at multiple time points
Kain et al[11], 2007	United States	Four-arm RCT	204 dyads, 2-10 years	Elective outpatient surgery under general anesthesia	Control vs PPIA vs ADVANCE vs midazolam	mYPAS, STAI, emergence outcomes
Kain et al[33], 2003	United States,	RCT	80 dyads, 2-10 years	Elective surgery under general anesthesia	PPIA vs control vs PPIA + midazolam	mYPAS, STAI, physiological markers
Kain et al[16], 2000	United States	Randomized comparative trial	103 children, 2-8 years	Elective surgery under general anesthesia	Midazolam vs midazolam + PPIA	mYPAS, STAI

ICC: Induction Compliance Checklist; mYPAS: Modified Yale Preoperative Anxiety Scale; PAED: Pediatric Anesthesia Emergence Delirium Scale; PPIA: Parental presence during induction of anesthesia; RCT: Randomized controlled trial; STAI: State-Trait Anxiety Inventory; VAS: Visual analogue scale.