anestesia pediátrica - GL AAP

[Lisieux Eyer de Jesus]

1. the patient’s medical condition should be “optimized” when he or she presents to the operating room

2. The second step in preparing patients is to educate the family about the process of going to the OR and to help them advocate for a process that works best for them and their child.

3. In many cases, children and their families benefit from preoperative sedation. Younger children (2–5 years of age) and patients who have been to the OR before are at higher risk of being stressed and uncooperative during the induction of anesthesia.8 In addition, some patients will suffer from postoperative behavioral changes, including sleep difficulties, which may present to the pediatrician in the weeks after surgery. Recent studies have concluded that the likelihood of these maladaptive behaviors is higher if the child is anxious preoperatively.

4. Pediatricians should encourage adolescent patients to ask questions to make sure they understand what is planned.

5. Patients with complex medical and surgical conditions can benefit from a thorough preoperative assessment by an anesthesia care provider. Ideally, these preoperative evaluations take place in advance of the day of surgery, to avoid last-minute cancellations that occur because of missing data critical to optimizing the patient’s condition for surgery.

6. Planning for anesthesia benefits from communication about neurologic development and function, airway anomalies (eg, difficult intubations, history of airway surgery), cardiac and pulmonary function (including sleep apnea as well as lung disease), coagulation history, endocrine and renal diseases, and history of exposure to chronic opioids, anesthetics, and sedatives.

7. Conditions such as severe anxiety or posttraumatic stress disorder or conditions that impair the child’s ability to process information (eg, attention deficit disorder) or interact with strangers under stressful conditions (eg, oppositional defiant disorder, autism spectrum disorders) should be conveyed to the anesthesia care team.

8. Most regularly prescribed medications can be taken with a sip of water on the day of surgery and not violate NPO standards. 

9. Four items of family history are particularly important: malignant hyperthermia (MH), prolonged paralysis after receiving succinylcholine (pseudocholinesterase deficiency), bleeding diathesis, and Post-operative nausea and vomiting.

10. There is no role for routine laboratory

testing of healthy children undergoing procedure with minimal risk of blood loss or for neurologic, cardiac, or pulmonary compromise. Some centers require hemoglobin testing for infants and for patients having surgery in which blood loss is expected. In healthy children, laboratory and radiologic testing should be limited to situations in which the history or physical examination raises a specific possibility of risk.

11.“Red flag” conditions include: previous difficulties with intubation or mask ventilation, Pierre Robin syndrome, Treacher Collins syndrome, Goldenhar syndrome, Down syndrome, Klippel-Feil syndrome, mucopolysaccharidoses, previous airway or cervical spine surgery, prolonged neonatal intubation, and stridor at rest.

12. When compared with infants born at term, former preterm infants (born at <37 weeks’ gestation) are estimated to be at higher risk of postoperative apnea and bradycardia after general anesthesia until a postconceptual age of approximately 60 weeks.28 Parents of former preterm infants should be counseled to expect an overnight stay after surgery.

13. First, patients with a mediastinal mass (most often with a new lymphoma diagnosis) are at risk for lethal airway or great vessel compression on induction of anesthesia.33 Important signs include the inability to lie supine, dyspnea on exertion, plethora of head and neck, and biphasic stridor. 

14. Difficulties in sensory processing and the social interaction often make the perioperative period difficult for children with autism spectrum disorders.cet