From the Guidelines
A comprehensive pre-operative evaluation for a 2-year-old should include a thorough history, physical examination, and targeted laboratory testing based on the child's health status and planned procedure. Begin with a detailed medical history including birth history, previous anesthesia exposure, family history of anesthesia complications, current medications, allergies, recent illnesses, and immunization status 1. The physical examination should focus on the airway, cardiopulmonary system, and any congenital anomalies. Laboratory testing should be selective rather than routine; a complete blood count may be warranted if there are concerns about anemia or infection, while additional tests like coagulation studies, electrolytes, or chest X-rays should only be ordered if indicated by history or physical findings.
Key Considerations
- Children with complex medical conditions may require specialty consultation
- NPO guidelines should be followed: clear liquids until 2 hours before anesthesia, breast milk until 4 hours before, and formula/solid foods until 6 hours before
- Parental presence during induction can reduce anxiety, and premedication with oral midazolam (0.5 mg/kg, maximum 20 mg) 20-30 minutes before separation may be beneficial for anxious children
- Psychological preparation is particularly important in this age group where separation anxiety and fear are common, and play specialists and experienced nurses can help with psychological preparation and hence avoid distress in the anaesthetic room and refusal on the day 1.
Additional Recommendations
- Pre-anaesthetic assessment is also an opportunity to establish who has parental responsibility and to ensure that appropriate consent procedures are followed
- A discussion regarding anaesthesia should also take place with the parent, including common complications and side-effects of anaesthesia, and different issues need to be emphasised according to the age of the child 1. This approach balances the need for safety with avoiding unnecessary testing in healthy children.
From the Research
Pre-operative Evaluation of a 2-year-old
Overview of Preoperative Care
Preoperative care refers to the physical and psychosocial care that prepares a patient to undergo surgery safely 2. This care begins when the patient is booked for surgery and ends with their transfer to the theatre or surgical suite.
Preoperative Tests and Clinical Assessments
Various preoperative tests and clinical assessments can be undertaken during a preoperative outpatient appointment, one week or more before surgery takes place 2. These may include:
- Complete Blood Count (CBC) to evaluate the total numbers and characteristics of cell components in the blood 3, 4, 5, 6
- Other laboratory tests to assess the patient's overall health and identify any potential risks or complications
Application of Preoperative Care to a 2-year-old
When evaluating a 2-year-old for preoperative care, it is essential to consider their unique needs and developmental stage. This may involve:
- Conducting age-appropriate preoperative tests and assessments
- Providing patient information and education to the child's parents or caregivers
- Ensuring that the child is prepared physically and emotionally for surgery
Role of Complete Blood Count (CBC) in Preoperative Evaluation
The CBC is one of the most frequently ordered laboratory tests in medicine and can provide valuable information about a patient's overall health 3, 4, 5, 6. The components of the CBC include:
- Red blood cell count
- Hemoglobin
- Hematocrit
- Red blood cell indices
- Reticulocyte count
- White blood cell count and differential
- Platelet count
These components can help identify potential risks or complications, such as anemia or infection, and inform the development of an appropriate preoperative care plan.