Perioperative Approach To Children

Department of Pediatric Dentistry
Lutheran Medical Center
Date: 05/22/2009
Article title: Perioperative Approach To Children
Author(s): Zuckerberg Aaron L.
Journal: Pediatric Anesthesia
Volume (number): 41 number 1
Month, Year: Feb 1994
Major topic: Pediatric Anesthesia
Minor topics: Outpatient surgery
Type of Article: Professional Paper

Main Purpose:
Review the importance of child management in the perioperative period.
Overview of method of research: Professional paper with review of literature.

Findings:
The current trend toward treating pediatric patients under general anesthesia in outpatient clinics means that anesthesiologists often have little contact with the patient outside of the OR. Therefore, the responsibility of the perioperative care falls on the pediatrician and referring doctor. Psychological preparation of the child and family is extremely important.

Key points/Summary :
Parental Anxieties: many things that are routine to health care providers can be very frightening to parents. It’s important to establish trust with parents and provide them factual help to allay fears.

Childhood anxieties: children have many strange ideas about what may happen to them when they are in surgery. Being “put to sleep” also has negative connotations for children ranging from punishment to their pet’s euthanasia. Using play and imagination to help the child manage the situation can be helpful.

Psychological consequences of anesthesia and surgery
acute: emergence can range from calm to very wild. Data show that children who have a calm induction are more likely to emerge quietly.
chronic: some children can experience behavior changes after surgery and anesthesia. This is not a concern unless it persists beyond 2 weeks. Anxiety is the most common behavior changes, but regression, interpersonal disturbances, sleep anxiety and eating disturbances have all been recognized.

Advantages of outpatient surgery: cost, minimal parent-child separation, rapid return to daily life, restoration of parental control, reduction of nosocomial infections.

The limitations of outpatient surgery: parents struggle to take time off work and may be poor at providing post-operative care. Fear of the unknown is less because the child spends more time in the hospital.

Induction: in most settings, parents are present for induction. Having the parent wear a gown and hat can help the child wear his own gown and hat. The anesthesiologist can also use time before the induction to create a relationship with the child. The author recommends puppet shows, magic tricks and creation of balloon animals.

Perioperative sedation: in the past nearly every child was premedicated. Having parent present for induction basically obviates the need for premedication. Also you want a good airway for induction, which is another reason not to premedicate. The anesthesiologists should also tailor the induction to account for any limiting factors.

Postoperative period: parents want to be with their children as soon as they come out of surgery to verify to themselves that the child has survived and to support the child in recovery. Usually parents are allowed to be involved once anesthesia has turned the child over to PACU. Adequate post surgery analgesia must also be accounted for.

Assessment of article: Good review of many factors involved in taking care of patients when any level of sedation is involved.