Management of perioperative stress in children and parents. Part I--the preoperative period.

Hospitalisation and surgery are undoubtedly one of the most difficult experiences the children and their parents have to face. The lack of appropriately provided information about treatment and other hospitalization-related aspects increases anxiety and uncertainty. Besides showing sincere empathy, physicians working with paediatric patients should know the strategies to reduce perioperative stress in children and their families. The first part of our paper describes various well-tried methods of preoperative management, some of which can be applied before hospitalization. The crucial elements of such a strategy are to dissipate the emerging doubts by providing children and parents with relevant and understandable information and to familiarise them with the hospital setting.

Management of perioperative stress in children and parents. Part II--anaesthesia and postoperative period.

The majority of children, even those well prepared and with positive attitudes, experiences stress in the operating theatre and during the postoperative period. In some cases, the stress is even stronger for their parents. The role of anaesthetists is to minimize the unpleasant sensations by providing painless vein cannulation, uneventful induction of anaesthesia, suitably planned and timed analgesia, and prevention of postoperative vomiting. The effectiveness of combined analgesics, early administration of saturating doses and analgesia supplemented or based on methods of block anaesthesia - particularly on peripheral and local blocks, less appreciated in children, have been highlighted. Such a stress-reducing strategy should be initiated before hospitalisation and consistently continued to its completion or even longer, the example of which are one-day surgery patients who should receive prescriptions for or suitable drugs (mainly analgesics) on discharge for use in the home setting. Preparation of local programmes for management reducing surgery-associated stress in children is worth recommending.