What should I ask the parents for pre‑operative clearance of a child (including age, weight, height, gestational age at birth, chronic medical conditions, prior surgeries or anesthesia complications, current medications, drug/food/latex allergies, recent illnesses, immunization status, recent travel or sick contacts, nutrition/growth concerns, developmental or behavioral issues, family history of anesthesia complications or malignant hyperthermia, recent labs or imaging, and use of home oxygen or CPAP)?

Pre-operative Clearance History for Pediatric Patients

Obtain a comprehensive pre-operative assessment covering demographics, medical history, anesthesia risk factors, allergies, current health status, and family history to identify children who require specialized evaluation or modified anesthetic management. 1, 2

Essential Demographic and Growth Parameters

• Age, weight (in kilograms), and height to calculate medication dosing and assess developmental appropriateness 1
• Gestational age at birth because preterm infants may have sequelae such as apnea of prematurity that persist well into infancy 1
• Current corrected gestational age for infants, as those under 46 weeks post-menstrual age have up to 49% risk of postoperative apnea and require minimum 12 hours of continuous monitoring 3

Medical History and Chronic Conditions

• Chronic medical conditions including cardiac abnormalities (congenital heart disease, arrhythmias), pulmonary disease (asthma, reactive airway disease), neurologic impairments, obesity, genetic syndromes (Down syndrome with cervical spine instability, Marfan syndrome, skeletal dysplasia), renal or hepatic dysfunction 1, 2
• History of snoring or obstructive sleep apnea with specific queries about apneic episodes, frequent arousals, morning headaches, and daytime somnolence, as children with severe OSA require lower opioid doses and altered mu receptor sensitivity 1, 2
• Seizure disorder history and current control status 1
• Pregnancy status for females aged 12 and older, as up to 1% of menarchal females presenting for surgery at children's hospitals are pregnant 1

Prior Surgical and Anesthesia History

• Previous surgeries or anesthesia exposures with detailed inquiry about any complications, unexpected responses, or adverse events 1, 2
• Specific questioning about prior peri-operative collapse, severe bronchospasm, cardiovascular instability, or widespread urticaria during previous anesthetics, as one-third of such patients will have recurrence if the offending agent is not identified 4
• Summary of previous relevant hospitalizations 1

Comprehensive Allergy Assessment

• Drug allergies with detailed history of previous allergic or adverse drug reactions, including the specific reaction (rash, anaphylaxis, gastrointestinal upset) to distinguish true IgE-mediated allergy from recognized adverse effects 1, 4, 5
• Latex allergy screening by asking about reactions to latex-containing items (balloons, condoms, gloves) that produced itching, rash, or angioedema 4
• High-risk latex allergy groups: healthcare workers, children with spina bifida or multiple surgeries, individuals with severe hand dermatitis, atopic patients, and those allergic to banana, chestnut, or avocado 4, 2
• Food allergies particularly fruits associated with latex cross-reactivity 4

Critical pitfall: Approximately 45% of documented allergies in children are not true IgE-mediated allergies but rather recognized adverse effects or nonallergic concerns; verify each allergy with specific questions about the reaction to avoid unnecessary care alterations 5

Current Medications and Supplements

• All prescription medications with dosage, timing, route, and site of administration 1
• Over-the-counter medications 1
• Herbal medicines (St John's wort, ginkgo, ginger, ginseng, garlic, kava, valerian) as these may alter drug pharmacokinetics through cytochrome P450 inhibition, resulting in prolonged sedation with midazolam and other medications 1
• Illicit drug use in adolescents 1

Recent Health Status

• Recent illnesses particularly upper respiratory infections, as active infection may increase airway reactivity 2
• Immunization status to assess infection risk 1
• Recent travel or sick contacts 1

Nutrition and Development

• Nutrition and growth concerns including failure to thrive or feeding difficulties 1
• Developmental delays or behavioral issues including diagnosed emotional or behavioral problems that may benefit from mental health consultation before hospitalization 1

Family History

• Family history of anesthesia complications particularly malignant hyperthermia, as 75.9% of MH cases have no positive family history and 20.9% had previous uneventful anesthesia 6, 7
• Family history of pseudocholinesterase deficiency or muscular dystrophy 1

Recent Investigations

• Recent laboratory results if obtained (complete blood count, electrolytes, creatinine, coagulation studies) 2
• Recent imaging studies relevant to the surgical procedure 2

Special Equipment Needs

• Home oxygen or CPAP use indicating significant cardiopulmonary disease requiring specialized perioperative management 1

Consent and Communication

• Establish who has parental responsibility to ensure appropriate consent procedures are followed 1, 3
• Document all information in both the electronic medical record and on a patient wristband, with "Latex Allergy" notices posted on operating-room doors when applicable 4

Referral threshold: If the history suggests prior peri-operative anaphylaxis or is equivocal, refer the patient for allergy testing before elective procedures; emergency cases may proceed only when unavoidable with avoidance of all suspected agents 4