Implementation of virtual parental presence during induction of anesthesia: a single-site descriptive study at a pediatric academic center

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BACKGROUND: Preoperative anxiety in children can cause distress for patients, families, and care teams. Virtual Parental Presence during the Induction of Anesthesia (VPPIA) offers a novel way to maintain emotional support during inhalational induction, particularly in the wake of COVID-19-related restrictions on in-room parental presence. While prior studies suggest VPPIA is feasible and acceptable, practical insights on real-world implementation and coaching strategies remain limited. METHODS: This single-site, descriptive implementation study at a pediatric academic center evaluated the feasibility, perceived effectiveness, and user experience of VPPIA. Children aged 4–12 undergoing inhalational induction for elective surgery were enrolled along with their parents. All parents received standardized coaching via a 4-minute video on how to support their child during induction. On the day of surgery, a secure FaceTime call connected parents to children from preoperative separation through induction. Feasibility (e.g., OR delays, technical issues), anxiety (mYPAS), cooperation (CIBA), mask acceptance, and satisfaction were measured. RESULTS: Eighty-five parent-child dyads participated. VPPIA was highly feasible, with no OR delay in 97.6% and uninterrupted video in 94.1% of cases. Technical issues were rare (7.1%) and minor. Most inductions (94.1%) were rated as smooth, with 76.5% of children accepting the mask without fear. Providers rated VPPIA as “Effective” in 85.9% of cases. Median mYPAS scores remained the same from pre- to intra-induction. Patient and parent satisfaction was high, with 88.2% of children reporting a positive experience and 94.1% of parents indicating they would use VPPIA again. CONCLUSION: This descriptive study supports the feasibility and acceptability of VPPIA with brief parental coaching in real-world perioperative settings using standard hospital infrastructure. The combination of VPPIA and brief parental preparation was associated with smooth inductions and high satisfaction. These findings support VPPIA as a practical, family-centered strategy, especially when in-person parental presence is limited.

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