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?
- Discuss surgical plan with surgeon
- What are precise planned procedures, alternatives, positions?
- How can the anesthesiologist be most helpful?
- Review hospital charts, especially prior anesthesia records
- General state of health
- Chronic, or acute intercurrent diseases
- Prior anesthetic problems
- Medications, allergies
- Consult with patient's primary care provider
- Take medical history and review of systems from patient and/or caretakers
System review - cf. Table 1 for anesthetic implications of selected positive findings.
- Perform physical exam
- At least heart, lungs, airway and site of surgical interest
- Ages 4-8: loose or "missing" teeth
- Review results of laboratory test and consultations
- Obtain and analyze additional workup if necessary
- Review relevant literature, opinion
- Miller, Smith, Berry, Stehling etc. texts
- Literature review; Medsearch,
- Unusual syndromes and relation to perioperative care
One anomaly suggests another
- Discuss plans with patient and family
Elements of the anesthetic continuum
The anesthesiologist develops, for each case, an overall plan for integrating the elements
of the anesthetic continuum:
- Psychological preparation of child and family
- Premedication option
- Induction technic
- Intraoperative considerations
- Postoperative emergence, analgesia
- Follow up