From the Guidelines
For an 8-year-old requiring pre-operative clearance, a comprehensive evaluation including a thorough history and physical examination is crucial, with a focus on existing medical conditions, previous surgical experiences, medication use, allergies, and family history of anesthesia complications, as recommended by recent guidelines 1. The evaluation should be tailored to the child's individual needs, taking into account their developmental stage, as outlined in the American Heart Association's recommendations for preparing children and adolescents for invasive cardiac procedures 1. Key aspects of the pre-operative evaluation include:
- A thorough history and physical examination to identify any potential risk factors
- Basic laboratory tests, such as complete blood count and basic metabolic panel, as recommended by the American Family Physician guidelines 1
- Consideration of electrocardiogram if there is any cardiac history or symptoms
- Continuation of regular medications up to the day of surgery, unless specifically contraindicated
- Instruction to parents to keep the child NPO for 6-8 hours for solid foods and 2-4 hours for clear liquids before anesthesia
- Reporting of any recent illnesses, particularly respiratory infections within the past two weeks, which may necessitate postponing elective procedures This thorough pre-operative assessment is essential to identify potential risk factors that could affect anesthesia administration or surgical outcomes, ensuring the child's safety during the procedure and optimizing post-operative recovery, as emphasized by the guidelines 1.
From the Research
Preoperative Evaluation for an 8-Year-Old
The preoperative evaluation for an 8-year-old undergoing elective surgery with anesthesia is crucial to assess medical and psychosocial factors that may affect surgery timing and identify underlying conditions that require evaluation or management before surgery 2.
Key Components of the Evaluation
- The history component should include a review of the patient's medical, behavioral, and social history, as well as previous complications with surgery or anesthesia, medication review, and tobacco use history 2.
- The physical examination should involve identifying airway anomalies that could interfere with intubation and evaluating cardiac, respiratory, neurologic, and fluid status 2.
- Routine laboratory testing is not recommended for healthy children and adolescents having low-risk procedures, but patients with underlying conditions may benefit from targeted laboratory and imaging studies to assess clinical stability 2.
Anxiety Reduction
Many children have anxiety about surgery, which can be reduced by educational pamphlets, videos, coaching provided to parents the week before surgery, and parental presence during the induction of anesthesia 2.
Laboratory Tests
The complete blood count (CBC) is one of the most frequently ordered laboratory tests in medicine, and its components can be useful in predicting cardiovascular and metabolic diseases 3, 4, 5. However, for healthy children undergoing low-risk procedures, routine laboratory testing, including CBC, is not recommended 2.
Special Considerations
For pediatric patients, unique topics such as gestational age, respiratory and cardiovascular concerns, fasting guidelines, and management of preoperative anxiety should be considered 6.