New Assessment Tool Helps Detect Parental Behaviors That Lead to Poor Outcomes in Children Undergoing Surgery

Chicago — (October 18, 2011) 

A clinical study presented at ANESTHESIOLOGY 2011 highlighted a behavioral assessment tool that may help anesthesia providers identify pre-surgical behaviors in parents and children that lead to maladaptive behaviors in children after surgery.

According to lead researcher Nancy Hagerman, M.D., the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) uses a series of real-time measurements to determine the coping, distress and anxiety behaviors of children and parents before surgery, during induction of anesthesia and after surgery.

“The real-time advantage of PACBIS makes possible a number of potential clinical utilities, including immediate identification and targeted real-time behavioral and medical interventions for the modification of behaviors that are associated with poor perioperative outcomes in children,” said Dr. Hagerman, of the Cincinnati Children’s Hospital Medical Center.

In the study, which involved 405 children aged 3-12 undergoing outpatient tonsillectomy and adenoidectomy, Dr. Hagerman and her research group found that:

  • Better child coping before surgery and anesthesia led to less emergence delirium after surgery; children who scored high on the PACBIS “Child Distress” measurement before anesthesia had a 6-point increase in “Pediatric Emergence Delirium” compared to children with minimal “Child Distress.”
  • Negative PACBIS parental behaviors during anesthesia induction increased instances of separation anxiety and sleep disturbances in children; positive parental behavior, however, was shown to decrease maladaptive behaviors such as withdrawal and eating disturbances. 
  • When the PACBIS “Child Coping” and “Child Distress” measurements worsened by two units, there was an 80-percent increase in the odds of severe pain in days one and seven after surgery, respectively; positive PACBIS parental behavior correlated with a three-fold reduction in the child’s pain.

“Parents who cope well and provide distracting, nonprocedural talk during the stressful perioperative period help their child by reducing distress during induction, thereby decreasing the probability of emergence delirium, surgical pain and maladaptive behaviors,” said Dr. Hagerman.

Dr. Hagerman said that utilizing PACBIS will help anesthesiologists tailor perioperative management of children and help guide parents to use adaptive behaviors and interactions.


Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at To learn more about the role physician anesthesiologists play in ensuring patient safety, visit Join the ANESTHESIOLOGYTM 2014 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES2014.



American Society of Anesthesiologists