section name header

Questions

  

B.2. What preoperative orders are needed?

Answer:

Preoperative fasting is a prerequisite for elective surgery to reduce the risk of perioperative pulmonary aspiration. Fasting guidelines for infants and children in the United States follow the American Society of Anesthesiologists Guidelines (Table 42.1). It is important to avoid prolonged fasting times which lead to increased patient discomfort, caregiver dissatisfaction, and other adverse outcomes (dehydration, metabolic disturbances, hypoglycemia, difficult vascular access, arterial hypotension with induction, nausea, and vomiting).

Table 42.1: Minimum Fasting Period for Pediatric Patients

Clear fluids2 h
Breast milk4 h
Formula/Nonhuman milk/Light meal (eg, toast)6 h
Solids (eg, fried or fatty foods)8 h

Because multiple operations can be required, the emotional trauma of each hospital experience must be minimized. The most common premedication in pediatric patients is oral midazolam at doses from 0.25 to 0.5 mg/kg orally. Children younger than 8 months rarely require premedication. Children with anticipated difficulty in airway management and those with a propensity toward airway obstruction are safer without premedication.

The anesthesiologist might consider topical (eutectic mixture of local anesthetics, cream) or subcutaneous local anesthetic prior to peripheral venous access in patients with an expected difficult airway or for infants less than 6 months old if prolonged fasting is anticipated. This allows for the expeditious administration of emergency medications in the former and hydration with dextrose-containing fluids to avoid hypoglycemia in the latter.

Special orders include antibiotics if the infant or child has associated congenital heart disease and typing and crossmatching of blood for palatal surgery.

References