Preoperative Evaluation of Pediatric Patients

Introduction

Children are very dynamic type of patients. But they can get afraid and stressed after hearing about the surgery. Therefore, the team of doctors gives special care to such children or pediatric patients. All the patients require proper pre-evaluation before going for surgery and anesthesia (medicine to block pain during and after surgery). Pediatric patients are also given this necessary evaluation to prevent complications and harm. Preoperative evaluation is the necessary check-up before the doctor performs any surgical procedures.

Why Is a Preoperative Evaluation Done?

The preoperative evaluation is done on all the patients. The necessity of the evaluation is mentioned below:

• Evaluation of the patient before helps the doctor to plan the surgery.

• It helps in communicating with the patient before the surgery.

• It makes the doctor aware of any medical condition the patient is suffering.

• It familiarizes the child (patient) and the parents with the hospital.

What Is Done in a Preoperative Evaluation?

The objective of preoperative evaluations is for the doctor to pre-planning the surgery accordingly. The purposes of preoperative evaluation are:

• First, the medical history of the patient is taken.

• Then, a physical examination is performed.

• Inspection of the surgical body area.

• Obtaining the family history related to any conditions.

• Finally, required laboratory tests are performed.

What Does Medical History Involve?

Medical history has many parameters in it. For example, the pediatric patient's medical history involves:

• The birth history of the patient was premature or full-term at the time of birth. Premature births usually occur less than 37 weeks of pregnancy. If the patient is a premature baby, they might face problems related to immature lungs and airways. The premature born is mostly at high risk of postoperative apnea (breathing issues during sleep) and bradycardia (slow heart rate).

• Any medical illness the patient is suffering. The doctor requires special consideration if conditions like congenital heart disease (heart disease that is present during birth) or respiratory infection are present.

• History of any previous hospitalizations and surgery.

• Any allergy the patient is suffering from, like latex allergy, etc.

What Are the Steps Involved in a Physical Examination?

Physical examination of the patient is a crucial step in proceeding with surgery. The physical examination involves:

• Airway - The patient’s airway is checked. No airway anomalies should be present for clear unblocked airways.

• Dentition - Dentition also helps determine the patient's actual age.

• Inspection - Inspection of the heart, chest, and abdomen are done.

• Neurological Status of the Patients - The mental status, ability to walk, and body coordination come under it. Sometimes, a few questions are asked to the patients to check their brain activity.

What Does a Family History Contain?

Family history shows us that any risks or reactions to surgery patients will be linked genetically. It involves specifically:

• Any responses to surgery or anesthesia.

• Any history related to malignant hyperthermia (a serious reaction that occurs as a result of exposure to specific drugs used during anesthesia).

• Any sickle cell anemia deficiency of blood) history.

• Thalassemia (bleeding disorder) condition history.

• Pseudocholinesterase (enzyme needed to break drug used in anesthesia) deficiency history.

Suppose the patient has a family history of any of these. In that case, the patient is at high risk of developing complications, and the doctor has to be very conscious during surgery.

What Does a Laboratory Test Involve?

Laboratory tests involve:

• The blood tests for hemoglobin, prothrombin time, bleeding time, partial thromboplastin time, and platelet counts.

• Any radiographs if required.

• CT (computed tomography) scans or MRI (magnetic resonance imaging) reports on the requirement of the surgical needs.

What Are the Important Fasting Guidelines for Surgery of Pediatric Patients?

There are fasting guidelines for pediatric patients before going for surgery. They are very important and must be informed to the patient's guardian in the preoperative period. They are:

• If the child is on clear liquids, then two-hour fasting is required.

• If the child is on breastmilk, then four-hour fasting is required.

• If the child is on formula milk, then six hours of fasting is required.

• Eight hours of fasting is necessary if the child is on solids.

What Are the Major Issues That Require a High Concern During the Preoperative Evaluation Period?

The major issues that have high chances for complications are:

• Premature Born Child - The condition causes immaturely developed lungs with high complications. Any complications are prevented by admitting the patient for 24 hours postoperatively.

• Congenital Heart Disease - The heart has congenital (a condition that occurs during birth) diseases with abnormal heart murmurs (abnormal heart sounds). This condition requires antibiotic usage before the surgery so that heart infections can be prevented.

• Respiratory Infections - These infections affect the airway of children commonly. It includes common colds, sneezing, and coughing. They can cause complications like pneumonia (an infection that causes air sacs in the lungs to swell), laryngospasm (sudden contraction of the vocal cord), and bronchospasm (constriction of muscles in the windpipe). It is recommended to prevent any complications and to delay the surgical procedure.

• Asthma - It is a respiratory condition where the lining of the airways is constricted, and there is excess mucus production leading to cough and breathing problems. It can be managed by keeping the medication on up to the day of surgery and choosing suitable anesthesia further.

• Malignant Hyperthermia - Patients with a malignant hyperthermia history have the risk of developing it again. The condition is managed by using intravenous anesthesia. Succinylcholine should also be avoided in them.

What Is the Main Concept Behind Preoperative Evaluation?

The main concept of preoperative evaluation of pediatric patients is the anxiety of the patient and the parents after hearing surgery. The doctor should calm down the stress they feel after the consultation. The parents should be educated about the surgical procedure and its complications. The age issues regarding the surgery, the appropriate age for surgery, and surgery importance should be discussed. After this period, the patients will be going for surgery. So, it helps the parents and child communicate with the doctor and acknowledge the surgery.

Conclusion

All patients require a preoperative evaluation period, but pediatric patient evaluation requires communication between the child and the parents to the doctor. The doctor plays a role in calming their stressful situation. Preoperative evaluation is an essential step in surgery that involves the patient's medical history, family history, physical examination, and laboratory tests. All these are done to plan the surgery accordingly and manage the surgery after any known complications.