Pediatric Anesthesiology
Preoperative Preparation of the Pediatric Patient
Amanda's Story,
How NOT To Do It

Three-year-old Amanda began to cry as she and her mother entered the operating room. She was told that they were just going to put her to sleep so they could open her up to see why her tummy kept hurting, but she didn't seem to really understand what was going to happen. A doctor, who was turned away from her, was moving things around on a strange table and sticking needles into little bottles. Amanda didn't know anyone in the room. Then, someone picked her up and said, "Let's get this gown off." Amanda started screaming. She was then held down by two adults while she kicked and cried for her mother who stood tearfully behind one of the adults. "What about that cream that can be put on for needle sticks?" her mother asked. The doctor answered, "Not enough time for it to work. Besides it'll only hurt for a little while." While Amanda, restrained, screamed and kicked, four unsuccessful attempts were made to start an IV. "Let's gas her," someone said. "Gas?" her mother's voice cracked. Seemingly annoyed, the doctor said, "Let's just do it fast. She's pretty upset, now." Two adults pinned Amanda's shoulders to the table while the doctor shoved a plastic mask firmly down on her face. Amanda could now only kick, twist her head back and forth and emit muffled, terrified screams. "Oh my God. Is she all right?" her pale mother squeaked helplessly. "Sometimes you just need to hold them down," a nurse explained, "she's just going to have to learn to deal with it." Amanda's eyes rolled back in her head, her whole body relaxed until nothing seemed to be moving. The nurse caught her mother as she passed out. When Amanda's mother came to, she was sitting in a recliner in the recovery room. No one from the operating room was there. "They finally got started." someone told her.

In the operating room someone was saying "She looks blue to me." "Can't be. Pulse ox is 96," someone answered. Nervous dialogue ensued: "Not moving the bag. Where's a stethoscope? Never mind, just gimme an oral airway." "What size?" "Dunno, just try one. Any one." "Sat 65 now." "Start an IV." "Anyone have a stethoscope?" "Got a nasal airwy?" "Gimme an LMA, then." "I thought we decided to have an LMA available for this case?" "Sat 45." "$%&#@, gimme the tube!" "What tube, doctor?" "That one." "Can't see a @#$% thing in here!." "Where's the pediatric stylet?" "What's the dose of IM sux?" "Does she still have pulse?" "Will someone get me a stethoscope?"...

Maybe, the procedure was completed and when Amanda woke up, she began screaming and pulled out her IV. All she could remember was being held down, jabbed and poked with sharp needles and then suffocated with a plastic thing on her face. The next time Amanda came to the hospital for a clinic visit, she started to cry when the car pulled into the parking lot...


- G. Gordon, MD; liberally modified from Pediatric Anesthesia 6:249, 1996

Greg Gordon MD
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