Periprocedural Considerations

Periprocedural Considerations

1. Children face a multiple stressors in the perioperative period. They may not understand the specific disease; the concept of anesthesia, or the procedure itself. Honesty about the procedure(s), associated pain, and the sequence of events is essential in maintaining the trust of children regardless of their level of development.
   1. Approaches to optimize the periprocedural experience include the use of nonpharmacologic techniques. Examples of these strategies include distraction, humor, sharing control (e.g., would you like to sit up or lie down for induction?), and medical reinterpretation of equipment. The use of a child life specialist, tablet, and/or a teaching module may decrease the need for preprocedure pharmacologic therapy and improve a child's experience.
2. Infants less than 8 months old generally tolerate short periods of separation from parents and usually do not require premedication.
3. Children 8 months to 5 years of age likely have developed separation anxiety and may require sedation before the induction of anesthesia.
4. Older children generally respond well to information and reassurance. Parental and patient anxiety may be reduced by having parents accompany their children to the operating room. An especially anxious child may benefit from premedication.
5. Premedication with intramuscular (IM) anticholinergics generally is not recommended. If vagolytic drugs are indicated, they are usually administered intravenously (IV) at the time of induction of anesthesia.
6. In the presence of gastroesophageal reflux, ranitidine (2 to 4 mg/kg PO, 2 mg/kg IV) along with metoclopramide (0.1 mg/kg) can be administered 2 hours before surgery to increase gastric pH and reduce gastric volume.
7. Children receiving medications for medical problems such as reactive airways disease, seizures, or hypertension should continue to take these medications preoperatively.