Primary health care providers should play a leading role in the medical evaluation and psychological preparation of children before surgery or other procedures requiring anesthesia. The provider’s goal is to ensure that the child’s medical issues are clearly defined and that the physiologic impact and limitations imposed by each condition are well delineated. The primary care provider’s knowledge of the patient’s past medical history and the results of an appropriate physical and/or laboratory evaluation before anesthesia and surgery can provide valuable information to both the anesthesiologist and the surgeon in making the determination as to whether the procedure should take place.
The objectives of this review are threefold:
1. To describe medical issues of concern to anesthesiologists and surgeons to improve the effectiveness of medical consultations in the preoperative period; 2. To present information that will encourage and facilitate communication among surgeons, anesthesiologists, pediatricians, and other primary health care providers; and 3. To provide guidelines to pediatricians and other primary health care providers who are preparing patients and families for anticipated procedures.
ROLE OF THE SURGEON
The preoperative evaluation and preparation begins in the office of the primary health care provider. The referral to a surgeon should include a description of what the child and parent should expect during the visit to the surgeon. This will help reduce their anxiety and improve the interaction with the surgeon.
Three types of patients for whom surgeons are typically consulted for evaluation and treatment are the healthy child who is undergoing elective surgery, the chronically ill child who requires surgery, and the acutely ill or injured child who requires emergent surgery. When elective surgery is anticipated, the primary provider should communicate directly with the surgeon by written correspondence and sometimes by phone. The preoperative consultative evaluation by the surgeon will include a history of the current surgical problem, past medical history, and physical examination, and, if indicated, scheduling of preoperative laboratory and/or diagnostic studies. The surgeon will explain the surgical procedure to the parent and child and will include discussion of potential complications, postoperative care, anticipated outcome, and follow-up. The family should also be informed that surgery will likely be cancelled if a concurrent illness develops that would compromise the procedure, anesthesia, on postoperative recovery. The need for blood transfusion, as well as options for donation, should be discussed. The surgeon should communicate with the primary provider regarding the consultation. Adequate planning linking the primary care provider, surgeon, anesthesiologist, and other pertinent medical specialists is essential.
ROLE OF THE ANESTHESIOLOGIST
Anesthesia blunts the input and output of sensory, reflex, mental, and motor functions. It begins with the administration of agents that alter these activities. Anesthesia may begin outside the operating room with the administration of preoperative medication on after the patient enters the operating suite. The involvement of the anesthesiologist extends into the postoperative period until the patient is discharged from the post anesthesia care unit (PACU) or after release from the PACU if regional analgesia or “blocks” have been used for pain relief.
Anesthesiologists, surgeons, pediatricians, and other primary health care providers, nurses, and other health care personnel participate in preparing the child for anesthesia and surgery. Although each provider of care has his or her own perspective, many issues are common to all. The preparation should include the entire family if so desired by the family. Family members must be afforded an...