The term perioperative care refers to all the
clinical activities that take place around a surgical intervention,
from the preoperative assessment to the postoperative discharge.1-3 In
modern institutions, perioperative care is performed in a defined
physical area that usually accommodates scheduling, admission, preoperative
preparation, the procedure itself (the operating room or a procedural
suite), recovery from the procedure (phase I and II), and discharge.
Support services—including sterile processing, materials management,
the pharmacy, the laboratory, pathology, diagnostic imaging—are
frequently adjacent. The success and subsequent demand for new procedures such
as cardiac catheterization or endoscopy, which are not strictly
surgical but require expertise and equipment similar to surgery,
have created a need to duplicate existing perioperative resources
in other areas. The same principles that are detailed here for surgical procedures
apply to these procedural areas.
Anxiety is experienced by nearly all parents and children at
the prospect of surgery and anesthesia. Preparing children for their
surgical and operating room experience should begin before the patient
ever makes contact with their anesthesiologist. The surgeon or primary care
provider should be the first ones to ensure that the child receives
the best perioperative care possible and to assure the child’s
family that this will be the case, answering their questions or
facilitating access to someone who can answer them.
Many institutions arrange orientation and preoperative tour days
before surgery to instruct and educate the child and parent on what
to expect. As part of the preoperative program, most of these institutions
have developed “child-friendly” environments,
with coloring books, tours, videos, and the invaluable help of a
child-life specialist to help reduce the level of anxiety. Allowing
children to take a favorite toy or blanket into the operating room
provides great comfort to many children.1,4
The primary goal of preoperative assessment and
care is preparing a patient for surgery. This involves (1) screening
for conditions that may require consultation workup or treatment,
(2) optimizing any preexisting medical problems, and (3) counseling
patients and parents about the expected course of anesthesia and
surgery. The anesthesiologists should make every effort to see the
child and the family to understand their needs and expectations
and to perform a complete preoperative evaluation. The anesthetic,
postoperative pain management, and discharge plans can be all be
explained to the child, if appropriate, and to the family at this
time. This is also a good opportunity to obtain informed consent.
The preoperative evaluation usually consists of a careful history
and an oriented physical examination aimed at establishing surgical
risk and designing anesthetic planning and postoperative care. The
physical examination should be sufficiently complete to detect any
major problems and should be informed by the medical history (Table 112-1).
Table 112-1. The Preanesthetic
History, Systemic Review, and Related Anesthetic Implications
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