Pediatric Anesthesiology
Preoperative Preparation of the Pediatric Patient - 3
Preoperative Education

Pediatric anesthesia is a family affair.

Psychological preparation involves recognizing and ameliorating stress experienced by the child and family. Sources of stress include separation of child from parents, strange surroundings ("fear of the unknown"), painful procedures, frightening procedures, survival.

The two most important sources of stress are:
1. Fear of the unknown
2. Fear of separation

These stresses are best dealt with by:
1. Simple, honest communication, colored by appropriate positive suggestion, and modified according to the age of the patient.
In other words: tell 'em just what's gonna happen, in a positive, supportive way.
2. Maintain parental presence during induction of anesthesia in selected cases.

Approach depends on age of patient:

Early infancy (neonate to about 7 months of age): Parents are the primary focus. Gentle, comfortable separation is almost always possible before induction of anesthesia.

Later infancy to about 3 years: Separation anxiety is major consideration. Surgery ought be performed on outpatient bases if possible. Careful selection regarding parental presence.

3 to 6 years: Child becomes primary focus. Fear of unknown dealt with by explaining exactly what will happen; what you will do. Then make sure you do it that way. (Be trustworthy!)

6 years to adolescent: Increasing involvement of patient.

From 3 or 4 years through adolescence: Give child choices. Parental presence often helpful.

Greg Gordon MD