Preoperative preparation and premedication.

Preparing the paediatric patient for their operating room experience can be a complex process because of the many individuals involved.4 36 38 Preparation begins before patients have seen an anaesthetist because they will learn of their impending surgery from the surgeon. Surgical colleagues and their support staff can help to ease parents’ anxieties by assuring them that their child will receive the best anaesthetic care possible. The anaesthetist may first meet the child in a preoperative screening clinic a week or two before the scheduled surgery or on the morning of the procedure. Increasingly, in countries trying to reduce health care costs there may be only a few minutes to interview and evaluate the family and child. The use of preoperative hospital tours, educational videos and pamphlets have been demonstrated to have value in reducing patient and parent anxiety.54 Educational tours appear to have particular value for children older than 6 yr.51 Parents of children less than 1 yr of age and those undergoing surgery for the first time are particularly anxious.66 In the USA, approximately 80% of paediatric surgical procedures are performed on an outpatient basis or on a ‘same day admission’ basis. Although cost effective, this shortened process limits the time that the anaesthetist has to evaluate the child. Screening clinics help in arranging evaluation of underlying medical conditions (seizure disorders, asthma, diabetes, severe cardiac, pulmonary, renal, hepatic, neurological, metabolic or haematopoietic problems). Preoperative phone calls are of great value in helping to ascertain if the child is suffering from an acute upper respiratory tract infection (URTI) which might warrant postponing an elective procedure.91 Cancellation because of a URTI causes economic loss because of the parents need to take time off work to bring their child to hospital only to find the procedure cancelled. A telephone call the day before might avoid this problem.