Preoperative Evaluation: Perspective of Pediatrician Preoperative Evaluation of Pediatrician

Öz

Aim: Pediatric patients in the preoperative period have two important aspects: psychological assessment with examination and treatment. The participation of pediatricians such as anesthesiologists in the preoperative evaluation contributes to the reduction of these problems in both aspects. The aim of this study is to present the pediatric polyclinic evaluation analytically for the patients who need to receive anesthesia for a variety of reasons within a 3-month period.
Materials and Methods: All patients who applied to the outpatient clinic for pre-anesthesia evaluation in the 3-month period between December 2018 and March 2019 were included in the study. While evaluating the patients, concurrent patient evaluations were recorded in the prepared forms. No patient was excluded from the study.
Results: 152 children were evaluated before anesthesia. The mean age of the children was 64.05±52.27 months. 89 (58,6%) of the patients were male and 63 (41,4%) were female. 44,7% of them were referred from the Ophthalmology department in 17,1% of patients, anesthesia was postponed. The most common cause was upper respiratory tract infection. 20 children showed the need for subspecialty consultation. It was found that 40% of the cases had Pediatric Cardiology subspecialty consultation. The mean postponement time was 5,5 days. 23 children were investigated because of additional health problem.
Conclusion: Pediatricians are in a position to be an important part of the perioperative care team during and after surgery and anesthesia. They have important responsibility both for bringing the medical status to ideal conditions and for reducing the anxiety of the family and the child. They should also be aware of other underlying diseases.

Anahtar Kelimeler

• preoperative,evaluation,pediatrician

Preoperatif Değerlendirme: Pediatrist Bakış Açısı Pediatristin Preoperatif Değerlendirmesi

Öz

Amaç: Preoperatif dönemde çocuk hasta değerlendirmenin tetkik ve tedavi ile psikolojik olmak üzere iki önemli yönü vardır. Anestezi hekimleri gibi pediatristler de preoperatif değerlendirme katılımının olması bu sürecin iki yönüyle de daha az sorunla atlatılmasına katkı sağlamaktadır. Hastanemizde çeşitli sebeplerden dolayı anestezi alması gereken hastaların pediatri poliklinik değerlendirmesi analitik olarak sunmak amaçlanmıştır.
Gereç ve Yöntemler: Aralık 2018 ile Mart 2019 tarihleri arasında 3 aylık dönemde anestezi öncesi değerlendirme için ayaktan polikliniğe başvuran tüm hastalar çalışmaya alındı. Hazırlanan formlara eş zamanlı hasta değerlendirmeleri kaydedildi ve incelendi. Başvuran hiçbir hasta çalışma dışı bırakılmadı.
Bulgular: 152 çocuk anestezi öncesinde değerlendirildi. Çocukların ortalama yaşları ay cinsinden 64,05±52,27 idi. Hastaların 89 (%58,6)’ u erkek, 63 (%41,4) tanesi kızdı. %44,7 ile en sık göz hastalıkları tarafından yönlendirilen çocuklara preoperatif değerlendirme yapılmıştır. Hastaların %17,1’ inde anestezi ertelenmesi önerilmiş. En sık neden ise üst solunum yolu enfeksiyonu olduğu görülmüştür. 20 çocukta yan dal konsültasyonu ihtiyacı görüldü. En sık %40 oranında Çocuk Kardiyoloji yan dal konsültasyonu olduğu saptandı. Ortalama erteleme süresi 5,5 gün idi. 23 çocukta ise mevcut tanılarına ek saptanan sorunlar nedeniyle araştırıldı.
Sonuç: Pediyatristler hasta çocuk ve ailesini cerrahi ve anesteziye hazırlama sırasında ve sonrasında perioperatif bakım ekibinin önemli bir parçası olmak konumundadırlar. Hem tıbbi durumunun ideal koşullara getirilmesi hem de aile ve çocuğun kaygısının azaltılması noktasında önemli sorumluluk taşırlar. Ayrıca altta yatan diğer hastalıkları için dikkatli olmalıdırlar. 

Anahtar Kelimeler

• preoperatif,değerlendirme,pediatrist

Kaynakça

1. 1. Goldschneider KR, Cravero JP, Anderson C, Bannister C, Hardy, Honkanen A et al. The pediatrician’s role in the evaluation and preparation of pediatric patients undergoing anesthesia. Pediatrics 2014; 134: 634-641.
2. 2. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS et al. Society for ambulatory anesthesia. society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007; 105: 1615–1628.
3. 3. Cordier W, Steenkamp V. Herbal remedies affecting coagulation: a review. Pharm Biol 2012; 50: 443–452.
4. 4. Beckert BW, Concannon MJ, Henry SL, Smith DS, Puckett CL. The effect of herbal medicines on platelet function: an in vivo experiment and review of the literature. Plast Reconstr Surg 2007; 120: 2044–2050.
5. 5. Birnkrant DJ, Panitch HB, Benditt JO, Boitano LJ, Carter ER, Cwik VA et al. American College of Chest Physicians consensus statement on the respiratory and related management of patients with Duchenne muscular dystrophy undergoing anesthesia or sedation. Chest 2007; 132: 1977–1986.
6. 6. Wernovsky G, Rome JJ, Tabbutt S, Rychik J, Cohen MS, Paridon SM et al. Guidelines for the outpatient management of complex congenital heart disease. Congenit Heart Dis 2006; 1: 10–26.
7. 7. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M et al; Prevention of infective endocarditis: American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; American Heart Association Council on Cardiovascular Disease in the Young; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 1736–1754.
8. 8. Elwood T, Bailey K. The pediatric patient and upper respiratory infections. Best Pract Res Clin Anaesthesiol 2005; 19: 35–46.

9. 9. Parnis SJ, Barker DS, Van Der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections Paediatr Anaesth 2001; 11: 29–40.
10. 10. Coté CJ, Zaslavsky A, Downes JJ, Kurth CD, Wellborn LG, Warner LO et al. Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 1995; 82: 809–822.
11. 11. Anghelescu DL, Burgoyne LL, Liu T, Li CS, Pui CH, Hudson MM et al. Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses. Paediatr Anaesth 2007; 17: 1090–1098.
12. 12. Huettemann E, Junker T, Chatzinikolaou KP, Petrat, Sakka SG, Vogt L et al. The influence of anthracycline therapy on cardiac function during anesthesia. Anesth Analg 2004; 98: 941–947.
13. 13. Hudson MM, Rai SN, Nunez C, Merchant TE, Marina NM, Zalamea N et al. Noninvasive evaluation of late anthracycline cardiac toxicity in childhood cancer survivors. J Clin Oncol 2007; 25: 3635–3643.
14. 14. Latham GJ, Greenberg RS. Anesthetic considerations for the pediatric oncology patient— part 2: systems-based approach to anesthesia. Paediatr Anaesth 2010; 20: 396–420.