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

Table 3 Summary of key quantitative findings and clinical interpretation

Ref.	Country	Child anxiety at induction	P value	Clinical interpretation
Yarımoglu et al[19], 2026	Turkey	Both parents: 25.8 (23.3-35.8) vs one parent: 33.3 (28.3-46.7)	0.009	Two-parent presence may reduce choice-related distress in selected children
Matava et al[18], 2024	Canada	vPPIA + coaching: 25.3 ± 2.3 vs baseline 27.7 ± 5.3	0.10	Pilot data; coaching and virtual support are promising but not definitive
Jain et al[27], 2023	India	PPIA: 63.19 ± 25.31 vs midazolam: 31.30 ± 12.04	0.001	Standalone PPIA underperformed compared with pharmacological anxiolysis
Ismail and Mahrous[28], 2022	Egypt	Active participation: 42.07 ± 4.93 vs presence only: 49.87 ± 5.36	< 0.001	Active parental role was superior to passive presence
Yao et al[29], 2022	China	PPIA: 31.45 (IQR 10) vs control: 89.3	< 0.001	PPIA reduced anxiety; combined PPIA + dexmedetomidine had strongest overall profile
Rasti-Emad-Abadi et al[30], 2017	Iran	PPIA: 67.83 ± 16.78 vs control: 70.39 ± 20.93	0.621	No significant reduction in child anxiety
Sadeghi et al[31], 2017	Iran	PPIA + midazolam: 35.5 ± 16.6 vs midazolam alone: 59.8 ± 22.4	< 0.001	Improved induction anxiety and cooperation in this trial; differs from older midazolam-addition data
Vagnoli et al[32], 2010	Italy	PPIA alone: 65.40 ± 24.97 vs PPIA + midazolam: 49.72 ± 22.86	< 0.001	Medication or clown-based adjuncts outperformed PPIA alone
Wright et al[17], 2010	Canada	PPIA: 54.18 ± 27.90 vs absence: 52.75 ± 24.27 at induction	0.001 across time pattern	Benefit was greatest at separation, not induction
Kain et al[11], 2007	United States	PPIA: 50 ± 26 vs control: 52 ± 26; ADVANCE: 43 ± 23	0.07 for PPIA vs control; 0.018 for ADVANCE effect	Structured preparation outperformed simple presence
Kain et al[33], 2003	United States,	PPIA: 35 ± 17 vs control: 42 ± 20	0.024	Some child-anxiety benefit, but parental physiological stress increased
Kain et al[16], 2000	United States	No significant difference between midazolam + PPIA and midazolam alone	0.28	PPIA was not additive to midazolam for child anxiety

vPPIA: Virtual parental presence during induction of anesthesia; PPIA: Parental presence during induction of anesthesia; IQR: Interquartile range.