Pediatric Anesthesiology
Preoperative Preparation of the Pediatric Patient - 5

Developing an Overall Plan Integrating the Elements of the "Anesthetic Continuum"

Focus on answering at least three basic questions

• Is the patient in optimal health?
• Can or should the patient's health be improved?
• Anything hidden here that could unexpectedly influence perioperative events?

General method

1. Discuss surgical plan with surgeon
   • What are precise planned procedures, alternatives, positions?
   • How can the anesthesiologist be most helpful?
2. Review hospital charts, especially prior anesthesia records
   • General state of health
   • Chronic, or acute intercurrent diseases
   • Prior anesthetic problems
   • Medications, allergies
3. Consult with patient's primary care provider
4. Take medical history and review of systems from patient and/or caretakers
   System review - cf. Table 1 for anesthetic implications of selected positive findings.
5. Perform physical exam
   • At least heart, lungs, airway and site of surgical interest
   • Ages 4-8: loose or "missing" teeth
6. Review results of laboratory test and consultations
7. Obtain and analyze additional workup if necessary
8. Review relevant literature, opinion
   • Miller, Smith, Berry, Stehling etc. texts
   • Literature review; Medsearch,
   • Unusual syndromes and relation to perioperative care
     One anomaly suggests another
9. Discuss plans with patient and family

Elements of the anesthetic continuum

1. Psychological preparation of child and family
2. Premedication option
3. Induction technic
4. Intraoperative considerations
5. Postoperative emergence, analgesia
6. Follow up