Physically restraining children for induction of general anesthesia: survey of consultant pediatric anesthetists

Abstract

Our results are similar to the US Society of Pediatric Anesthesia members, suggesting this remains an issue internationally. Consideration of practices in other specialties gives some guidance. Our survey shows a range of views as to what physical restraint is or involves, and what constitutes acceptable practice regarding the use or avoidance of physical restraint. We were unable to demonstrate consensus.

Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians

“…Healthcare providers often take parental participation in restraint for granted (Hallström, Runeson, & Elander, 2002) and there are indications that parents provide most of the holding during procedures (Graham & Hardy, 2004; Homer & Bass, 2010; McGrath & Huff, 2003). The way healthcare providers understand the parents’ role and cooperate with them during restraint is important because it may be an opportunity to prevent restraint.…”

Perioperative and Anesthesia Guidelines for Children with Autism: A Nationwide Survey from Sweden

“…Time limitations posed additional obstacle in providing care to children with ASD; a lack of cooperation on behalf of the child, due to his or her disability, could increase the risk that the anesthetist would rely upon physical restraint to complete the treatment in an efficient timeframe. Ultimately, the lack of preparation and even the lack knowledge among anesthetists about ASD can led to inadequate preparation of the child prior to the treatment, resulting in the use of physical restraint for the child's anesthesia induction (17,18,23).…”

“…Caring for all children who require anesthesia-whether typically developing or diagnosed with an disorder-is an inherent challenge, especially in creating confidence in both the child and the parents to decrease anxiety about the impending procedure. Children with ASD pose an even bigger challenge for the nurse tasked to provide the child with care (15)(16)(17)(18).…”

“…Due to the problems children with ASD have with interpreting words, facial expressions, and other forms of non-verbal communication, establishing a rapport with the children becomes especially difficult (2,3,16). These difficulties can lead to higher risks of uncooperative behavior during anesthesia induction, making physical restraint more common among this group than among either typically developing children or children with other intellectual disabilities (15)(16)(17)(18).…”

“…In addition, the abnormal, unpredictable sensory reactions in children with ASD add to the nursing staff's difficulties in interpreting the child's reactions and providing resultantly tailored care. These difficulties can heighten the risk that physical restraint will be employed for anesthesia induction among this specific group of children compared to other children (15)(16)(17)(18). Therefore, establishing guidelines for the care of children with ASD could increase the probability for creating a non-threatening and adaptive environment for treating this particular group of patients.…”