Pediatric responsibilities for preoperative evaluation

Resident’s Name: Derek Banks Date: May 29, 2009
Article title: Pediatric responsibilities for preoperative evaluation
Author(s): Q Fisher, M Feldman, M Wilson
Journal: Journal of Pediatrics
Volume (number): 125:675-685
Month, Year: 1994
Major topic: Hospital Dentistry
Minor topic(s): Preoperative evaluation
Type of Article: Opinion Paper
Main Purpose: To explain the role of the pediatrician in the preoperative evaluation prior to procedures under general anesthesia
Overview of method of research: Subjective review of understanding among pediatricians of their role in the preoperative evaluation and suggestions for more thorough evaluation and communication between pediatrician and anesthesia provider.
Findings: Many pediatricians do not fully understand their role in the preoperative evaluation. Many will merely write that the patient is cleared for surgery without disclosing important health information that may be essential for proper management of the pediatric patient undergoing anesthesia. One thing that can easily go unreported by a child’s pediatrician is stable or self-limiting conditions such as asthma, asymptomatic heart murmur, well-compensated hemoglobinopathy, prior exposure to chemotherapy, or mild symptoms of upper respiratory tract infection. This study cites a 1988 study showing that the risk of serious injury or death resulting from anesthesia complications in the pediatric population is around 1:20,000 to 1:100,000. This paper states that preoperative evaluation is a three-part process, including 1. evaluation of current state of health with comparison to baseline, 2. assessment made of child’s ability to handle stresses of anesthesia and proposed surgery, and 3. measures to achieve optimal medical conditions in accord with the urgency of surgery are undertaken. A thorough medical history should be done, including family history. The child should be prepared psychologically for the anesthesia experience. A multisystem physical exam should be performed by the pediatrician and pertinent information given to the anesthesia team. Some other highlights were as follows: patients with URI can sometimes be seen, if no signs of systemic illness (e.g. fever) and no signs of tracheobronchial inflammation. If these symptoms are present, tx. should be delayed at least 4 weeks. For patients with seizure disorders medications can be taken the morning of the procedure. 10-35% of patients with spina bifida become sensitized to latex. Malignant hyperthermia shows autosomal dominant tendency, so family history is very important. Patients with T21 may have atlantoaxial instability. Diabetic patients best scheduled first thing in the morning. Preoperative bloodwork is not necessary for the otherwise healthy pediatric population
Key points/Summary : That about sums it up…
Assessment of article: Good summary. We should send it to every pediatrician we know.