Recent knowledge of preoperative evaluation and preanesthetic management in infants

ABSTRACT

Preoperative assessment and optimization of a patient's condition are important components of anesthesia practice. Improvements in evaluation and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. Although routine preoperative laboratory tests are ordered in many institutions, history taking and physical examination provide more information about patients than laboratory tests do. Therefore, history taking and physical examination should be used to direct test ordering, and a test should be ordered only if the results will impact the decision to proceed with the planned procedure or alter the care plans. Preoperative laboratory tests without specific indications lack clinical usefulness and may actually lead to patient injury because of unnecessary interventions, delay of surgery, anxiety, and even inappropriate therapies. After sufficient discussion between anesthesiologists and surgeons in each institution, diagnostic testing guidelines for the preoperative evaluation should be developed to improve patient care, standardize clinical practice, improve efficiency, and reduce costs. For preoperative management for infants, preoperative evaluation is similar to that for the adult, but reducing anxiety of patients and their parents is especially important. Although many nonpharmacologic methods are used to reduce anxiety, the pharmacologic methods are more effective than nonparmacologic methods. The administration of sedative premedication to infants who are about to undergo anesthesia and surgery can result in beneficial effects during the preoperative and postoperative periods by decreasing anxiety, increasing cooperation during anesthesia induction, and reducing negative postoperative behavioral responses.