Pediatric Anesthesiology

Preoperative Preparation of the Pediatric Patient - Table 1

Medical history and review of systems: anesthetic implications

System		History		Possible anesthetic implications
CNS and neuromuscular systems		Seizures		Medications: drug interactions, possible inadequate serum levels, valproate-induced hepatitis
		Head trauma		Elevated ICP, anemia
		Hydrocephalus		Possible elevated ICP
		CNS tumor		Possible elevated ICP; chemotherapeutic drugs and interactions
		Developmental delay		Bulbar dysfunction and risk of aspiration
		Neuromuscular disease		Altered response to relaxants
		Muscle disease		Possible risk of malignant hyperthermia, hyperkalemia after succinylcholine
Cardiovascular system		Heart murmur		Septal defect; avoid IV air bubbles; hemoconcentration; endocarditis prophylaxis
		Cyanosis		Right-to-left cardiac shunt: IV air bubbles; hemoconcentration; endocarditis prophylaxis
		History of squatting		Possible tetralogy of Fallot
		Diaphoresis with feedings		Congestive heart failure
		Hypertension		Possible coarctation of aorta; renal disease; pheochromocytoma
		Transplant recipient		Fixed heart rate; insensitivity to anticholinergic drugs
Respiratory system		Prematurity		Increased risk of postoperative apnea; possible lower respiratory tract illness
		Bronchopulmonary dysplasia		Lower airway obstruction; reactive airways; possible subglottic stenosis; possible postoperative hypoxia and apnea; pulmonary hypertension
		Lower respiratory infection, cough		Reactive airways; bronchospasm; medication history; drug interactions
		Croup		Possible subglottic stenosis/anomaly
		Snoring, sleep apnea		Perioperative airway obstruction; hypoxia
		Asthma		Beta-agonist or theophylline durgs; pulmonary hypertension or cor pulmonale; steroid use; adrenal insufficiency; postoperative hypoxia
		Cystic fibrosis		Drug interactions; pulmonary toilet; pulmonary dysfunction; reactive airways
		Recent cold		Possible lower respiratory tract infection; reactive airways
Gastrointestinal system		Vomiting/diarrhea		Electrolyte abnormality; dehydration; full stomach
		Growth failure		Possible anemia
		Gastroesophageal reflux		Risk of aspiration; reactive airways; hypoxia
		Jaundice		Altered drug metabolism; risk of hypoglycemia
		Liver transplant recipient		Altered drug metabolism; immunosuppression
Renal system		Frequency, nocturia		Unrecognized diabetes; urinary tract infection
		Renal failure/dialysis		Electrolyte abnormality; hyper- or hypovolemia; anemia; medication history
		Renal transplant recipient		Immunosuppression
Endocrine/metabolic system		Hypoglycemia		Hypoglycemia
		Diabetes		Insulin requirement; intraoperative hypoglycemia
		Steroid therapy		Adrenal insufficiency
		Pregnancy		Teratogenic effects of nitrous oxide and other drugs; risk of spontaneous abortion
Hematologic system		Anemia		Transfusion requirements
		Bruising, excessive bleeding		Coagulopathy
		Sickle cell disease		Anemia; transfusion; hydration; oxygenation; orthopedic tourniquet use
		AIDS		Susceptibility to infection; infectious risk to medical personnel
Allergies		Medication history		Drug reactions; drug interactions
Dental		Loose teeth		Dental trauma; aspiration of tooth