The Impact of Culture in Weight Loss Intervention Effectiveness Among Hispanic American Women with Overweight or Obesity: A Systematic Scoping Review.

Adenotonsillectomy is a common surgical procedure for the treatment of paediatric obstructive sleep-disordered breathing. However, emergence agitation (EA) is a frequent complication during recovery from general anaesthesia, characterised by crying, thrashing, disorientation and other agitated behaviours. Emergence agitation not only complicates post-operative care but may also lead to adverse events such as airway obstruction and surgical wound bleeding. Studies indicate that the incidence of EA in children can reach 48 per cent. The underlying mechanisms may involve residual effects of anaesthetic agents (e.g., sevoflurane), post-operative pain, unfamiliar environments and anxiety due to separation from parents. Currently, pharmacological interventions, such as dexmedetomidine or ketamine-based combinations, are commonly used to mitigate EA. However, these agents may cause side effects, including respiratory depression and delayed emergence. Therefore, exploring non-pharmacological intervention strategies is of great clinical significance. Parental presence has gained increasing attention as an effective measure to reduce peri-operative anxiety in children. Multiple studies have demonstrated that parental presence during induction of anaesthesia (PPIA) can reduce pre-operative anxiety levels. Nevertheless, its impact on the emergence phase remains controversial. Some researchers suggest that parental presence may reduce the incidence of EA by alleviating separation anxiety and enhancing the child’s sense of security. In contrast, other studies indicate that highly anxious parents may heighten their child’s perception of pain and increase the risk of post-operative complications. These conflicting results suggest that the timing, manner and psychological state of parents may critically influence the intervention outcome. One randomised controlled trial found that repetitive maternal voice guidance significantly reduced the incidence of EA, while another study emphasised that allowing the child to choose which parent accompanies them may be more effective in reducing post-operative delirium than having the parent unilaterally decide. Furthermore, post-operative pain is a significant trigger for EA. Pain assessment tools such as the Face, Legs, Activity, Cry, Consolability (FLACC) scale have shown that children often experience moderate to severe pain after adenotonsillectomy, which is significantly correlated with internalising problems in parents (e.g., anxiety and need for information). High parental anxiety may exacerbate the child’s pain experience through emotional contagion, leading to higher complication rates (e.g., 31.4 per cent–57.1 per cent). Therefore, while implementing parental presence, it is essential to assess and support the psychological state of parents. Previous research has primarily focused on PPIA or used audiovisual interventions (e.g., video demonstrations or voice guidance) to indirectly simulate parental presence. Few studies have investigated the immediate effects of direct parental touch and companionship during the emergence phase. Against this background, this study focuses on parental presence immediately after extubation during emergence and examines its effects on EA, pain levels and family satisfaction.