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Uvod: Obisk bolnišnice je za predšolskega otroka stresen dogodek, še posebej, če je zanj napovedan operativni poseg v splošni anesteziji. V pripravi otrokom in njihovim staršem pomaga celoten zdravstveni tim, saj se priprava deli na administrativni, psihološki in fizični del. Namen: Namen diplomskega dela je s pregledom literature predstaviti pripravo predšolskih otrok na operativni poseg v splošni anesteziji z vidika teščosti. Metode dela: V diplomskem delu je bila uporabljena opisna metoda dela s pregledom slovenske in angleške strokovne in znanstvene literature s področja predoperativne teščosti v povezavi z načrtovanim operativnim posegom v splošni anesteziji, ki je bila prvenstveno objavljena med letoma 2003 in 2020. Iskanje literature je potekalo v spletnem portalu digitalne knjižnice Univerze v Ljubljani (DiKUL), mednarodnih podatkovnih bazah CINAHL in Medline ter s pomočjo vzajemne kataloške baze podatkov COBISS.SI. Pregledane so bile tudi nekatere reference pridobljene literature. Rezultati: Svetovne smernice za predoperativno teščost predšolskih otrok večinoma temeljijo na režimu 6–4–2, ki narekuje, da se 6 ur pred uvodom v anestezijo prekine s trdo hrano, 4 ure prej doječi otroci prenehajo s pitjem materinega mleka ali mlečne formule, 2 uri prej pa se prekine tudi s pitjem bistrih tekočin. Posamezne smernice se razlikujejo glede na opombe (npr. ali je dovoljeno žvečenje žvečilke, koliko vode lahko popijejo skupaj z zdravili, itd.). V predoperativnem času je pomembno tudi opazovanje hidriranosti predšolskih otrok. Predšolski otroci so običajno normalno hranjeni, vendar lahko imajo specifično prehransko pomanjkanje zaradi bolezenskega stanja. Vsem predšolskim otrokom je ob sprejemu potrebno oceniti prehransko stanje in jim z ustrezno prehransko obravnavo zagotoviti optimalno prehranjenost. Razprava in zaključek: Predpisan čas predoperativne teščosti se pri predšolskih otrocih velikokrat podaljša, kar otrokom predstavlja dodaten psihični stres in obremenitev za njihovo telo. Poleg tega so otroci bolj dovzetni za stranske učinke teščosti kot odrasli. Raziskovalci se zato nagibajo k spreminjanju obstoječih smernic s skrajšanim časom, ko je še dovoljeno pitje bistrih tekočin, saj to pripomore k zmanjšanju pooperativne slabosti in bruhanja. Podobno je tudi s prehranskimi nadomestili z ogljikovimi hidrati, ki ravno tako zmanjšujejo pojavnost slabosti in bruhanja v pooperativnem obdobju, poleg tega pa tudi pripomorejo k vzdrževanju normalnega nivoja sladkorja v krvi in zmanjšujejo možnost za nastanek pooperativnih vnetji. Menimo, da se kljub pozitivnim učinkom dobre hidracije in prehranjenosti pri predšolskih otrocih v predoperativnem obdobju veliko premalo upošteva njun pomen ter se tako veliko bolj poudarja pomen teščosti. Introduction: Going to hospital can be a stressful experience for preschool children especially when they have to be admitted for an elective surgery that requires going under general anaesthesia. The whole health care team including the nursing staff take part in preparing children and their parents for surgery. The preparation has three aspects: administrative, psychological and physical. Purpose: The purpose of this diploma work is to describe the process of preschool children in preparation for surgery in general anaesthesia regarding fasting. Methods: A descriptive method was used to review domestic and foreign literature. We searched for academic articles about fasting in preparation for surgery in preschool children. Literature was primarily published between the years 2003 and 2020. We searched for articles through Digital Library of University of Ljubljana web portal (DiKUL), international databases CINAHL and Medline as well as COBISS.SI library catalogue. We also reviewed some of the article's references. Results: Most commonly worldwide used guidelines for preoperative fasting in preschool children are based on the 6–4–2 regimen. Preschool children are allowed to eat solid foods up to 6 hours before induction of general anaesthesia, 4 hours before the surgery children have to stop being breastfed, and 2 hours prior to surgery children have to terminate drinking clear fluids. Some of the guidelines allow children to drink water with their prescribed medication up to 1 hour before surgery, some say children can chew chewing gum etc. In the preoperative period it is important to take into consideration how well hydrated children are. Preschool children are usually well nourished but despite that it has to be taken into consideration that their illness may cause them to lack some of the important nutrients. It is important to access how well preschool children are nourished when they are first hospitalised and to make sure they eat all the right nutrients. Discussion and conclusion: In paediatric surgery preoperative fasting times are often prolonged which can effect children's overall wellbeing. In addition, preschool children are more susceptible to side effects of preoperative fating. New research recommends changing current fasting guidelines from clear liquids for preschool children to shorter times before surgery as it has been shown to help prevent postoperative nausea and vomiting. When it comes to preventing children from eating before surgery it has been shown that preoperative carbohydrate loading helps maintain normal glucose levels and consequently lessens the occurrence of postoperative infections. Furthermore it also helps to prevent postoperative nausea and vomiting. In the process of reviewing literature for this diploma work we have found that health care workers give fasting more significance and do not emphasise the importance of hydration and nutrition in preschool children in preparation for surgery enough. |
