Parental presence in the operating room during emergency laparotomy

Abstract

We read with interest the results of the 7th National Audit Project (NAP7), dealing with peri-operative cardiac arrest in children [1, 2] and wish to discuss our experience of parental presence during resuscitation in the operating theatre.

An adolescent patient with suspected gastrointestinal bleeding needed urgent tracheal intubation for endoscopy and surgery. He arrived at the operating theatre unconscious and in profound shock. After successful tracheal intubation using videolaryngoscopy with local anaesthesia only, light sedation facilitated gastroscopy, and we prepared for surgery. An anaesthetist informed the parents of the need for resuscitation and the possibility of death and invited the parents to the operating theatre. The father chose to stay with his son during the surgery, holding his hand. A paediatric intensive care physician stood by his side. The child was resuscitated during surgery. He recovered neurologically, but experienced renal failure and required a prolonged intensive care stay. After reviewing the NAP7 studies, the anaesthetist involved contacted the parents to look back on the choices made.

The patient's mother expressed her gratitude for our decision to reflect on the event. During the surgery, she chose to remain outside the operating theatre to support other family members. However, she later questioned whether it would have been permissible for her to join her husband and son. Ultimately, she affirmed her decision made at that time and appreciated the option provided, as well as the transparent communication from our colleagues. She was concerned that her presence might impede our ability to care for her child, a consideration that had not occurred to us.

The father appreciated the chance to choose, stating he was not afraid at the time or traumatised later. He was glad to feel that he hadn't left the child behind and was “part of the team”. He also felt it helped him move on and process the event. Although he saw everyone working hard, he did not focus on the surgery or resuscitation details. Their religious beliefs were also very important in reflecting and accepting what had happened.

In urgent resuscitation during anaesthesia, consider inviting a parent to the operating theatre after a briefing and assigning a team member to support them. Assure parents their presence won't interfere with medical care. Good communication is essential even if having a parent in theatre isn't always possible.

Future research should provide guidance on the care of paediatric patients before, during and after resuscitation in surgery. This includes clear and timely communication of expectations and considering parental presence as part of the process.