| Popis: |
Adequate preparation of children for anesthesia allows optimization of medical conditions and leads to decreased morbidity. The medical history and laboratory testing obtained preoperatively aid the anesthesiologist in determining readiness for the planned surgery. Preparedness begins with adherence to a preoperative fasting schedule for elective surgery, selecting appropriate premedication, formulating an anesthetic plan and anticipating postoperative concerns. There are a variety of techniques for inducing general anesthesia. The technique used depends on a number of factors including the child's developmental age, understanding and ability to cooperate, previous experiences, the presence of a parent and the interaction of these factors with the child's underlying medical or surgical conditions. This chapter discusses special problems encountered in the pediatric population that require additional considerations from anesthesiologists. The preoperative period can be a stressful time for the fearful child and for those with autism spectrum disorders thus requiring the anesthesiologist to tailor the approach to meet the child's needs. Other challenges that pediatric patients present include respiratory system conditions such as obstructive sleep apnea syndrome, bronchopulmonary dysplasia, difficult airway, upper respiratory tract infections and apnea in former preterm infants. Additional conditions that are discussed include diabetes, seizure disorders, and sickle cell disease. Finally, the detection of a cardiac murmur, anemia or a fever before elective surgery will present a dilemma whether to proceed. The preoperative visit is an essential component of identifying the pediatric patient's needs and devising a plan that leads to a superior patient experience, a decrease in the number of cancellations and improved outcomes. |
