Pediatrik Hastaların Preoperatif Değerlendirmesi

Yıl 2014, Cilt: 36 Sayı: 1, 38 - 43, 20.06.2015

Cagil Vural

Öz

Pediatrik anestezide mortalite oranları gelişen anestezik yaklaşımlar ve artan bilgi
birikimiyle her ne kadar azalsa da, perioperatif morbiditeyi vurgulayan yayınlar günümüzde hala
mevcuttur. Bu hastalarda tam ve eksiksiz bir preoperatif değerlendirme mortalite ve morbidite
oranlarının azalmasında kilit basamaklardan birisidir. Her ne kadar anestezi alacak çocukların
çoğu sağlıklı olsa da altta yatan hastalıkların erkenden teşhis edilmesi perioperatif süreçte
karşılaşılacak komplikasyonları en aza indirger. Yine çocukların anatomik ve fizyolojik
farklılıklarının olması da bu hastalara yaklaşımda her zaman göz önünde bundurulmalıdır.
Hastaların değerlendirilmesinde çocuk için stres yaratacak her faktör en aza indirgenmelidir.
Gerek çocuk gerekse ailesi için ayrı bir stres kaynağı olan rutin testler, anamnez ve fizik
muayeneden bağımsız olarak istenmemeli, preoperatif değerlendirmede elde edilen bulgulara
yönelik seçici testler uygulanmalıdır. Hastanın temel fizik muayenesi havayolu, solunum sistemi
ve kardiyopulmoner sistem değerlendirmesinden oluşur. Bunlar dışında nöromusküler ve endokrin
sistem muayeneleri yapılmalı ve mevcut hastalıklarına yönelik hazırlıklı olunmalıdır. Bu derleme
çocuk hastaların anestezi öncesi değerlendirmelerinde ve hazırlıklarında dikkat edilmesi gereken
hususları vurgulamaya çalışacaktır.

Anahtar Kelimeler

preoperatif değerlendirme, anestezi, çocuk hastalar, morbidite

Kaynakça

• Ferrari, L.R. (2004). Preoperative evaluation patients considerations. 99(4):1058-69. surgical with multisystem Anesth Analg,
• Committee on, S. et al., (2012). Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Evaluation. 116(3):522-38. Preanesthesia Anesthesiology,
• Von Ungern-Sternberg, B.S. and W. Habre, (2007). Pediatric anesthesia-- potential risks and their assessment: part II. Paediatr Anaesth,. 17(4):311- 20.
• Mamie, C., et al., (2004). Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Paediatr Anaesth. 14(3): 218-24.
• Cohen, M.M. Cameron, C.B. and Duncan, anesthesia morbidity and mortality in the Analg. 70(2): 160-7. Pediatric perioperative period. Anesth
• Bancalari, E. and Clausen, J. (1998). Pathophysiology absolute lung volumes. Eur Respir J. 12(1): 248-58. changes in
• Olsson, G.L. and Hallen, B. (1984). Laryngospasm during anaesthesia. A computer-aided incidence study in 136,929 patients. Acta Anaesthesiol Scand. 28(5):567-75.
• Olsson, G.L.(1987). Bronchospasm during anaesthesia. A computer-aided incidence study of 136,929 patients. Acta Anaesthesiol Scand. 31(3):244- 52.
• Holzman, R.S. (1994). Morbidity and mortality in pediatric anesthesia. Pediatr Clin North Am. 41(1):239-56. 10. Stocks, J. (1999). physiology during early life. Monaldi Arch Chest Dis. 54(4):358-64.
• Nishino, T. Tagaito, Y. and Isono, S. (1996). Cough and other reflexes on irritation of airway mucosa in man. Pulm Pharmacol. 9(5-6):285-92.
• Rabbette, P.S. Costeloe, K.L. and Stocks, J. (1991). Persistence of the Hering-Breuer reflex beyond the neonatal period. J Appl Physiol (1985). 71(2):474-80.
• Tait, A.R., et al., (2001). Risk factors for perioperative adverse respiratory events respiratory Anesthesiology. 95(2):299-306. upper infections.
• Skolnick, E.T. et al., (1998). Exposure to environmental tobacco smoke and the risk of adverse respiratory events in anesthesia.Anesthesiology.88(5):1144- 53. general
• Tait, A.R. and Malviya, S.(2005). Anesthesia for the child with an upper respiratory tract infection: still a dilemma? Anesth Analg.100(1): 59-65.
• Aquilina, A.T., et al., (1980). Airway reactivity in subjects with viral upper respiratory tract infections: the effects of exercise and cold air. Am Rev Respir Dis. 122(1):3-10.
• Collier, A.M., et al.(1978).Spirometric changes in normal children with upper respiratory infections. Am Rev Respir Dis. 117(1):47-53.
• Rolf, N. and Cote, C.J. (1992). Frequency and severity of desaturation events during general anesthesia in children with and without upper respiratory infections. J Clin Anesth. 4(3):200-3.
• Maxwell, L.G. (2004). Age-associated issues in preoperative evaluation, testing, and planning: pediatrics. Anesthesiol Clin North America. 22(1):27-43.
• Farbod, F. Kanaan, H. and Farbod, J. (2009). Infective endocarditis and antibiotic dental/oral procedures: latest revision prior to to the guidelines by the American Heart Association published April 2007. Int J Oral Maxillofac Surg. 38(6): 626-31.
• Chadwick, V. and Wilkinson, K.A. (2004). Diabetes mellitus and the pediatric Anaesth. 14(9):716-23. Paediatr
• Smith, H.L. Meldrum, D.J. and Brennan, L.J. (2002). Childhood obesity: anaesthetist? 12(9):750-61. for Anaesth.
• Lazarus, R. et al., (1997). Effects of body fat on ventilatory function in children sectional findings from a random population sample of school children. Pediatr Pulmonol. 24(3):187-94.
• Pinhas-Hamiel, O. et al., (1996). Increased incidence of non-insulin- dependent diabetes mellitus among adolescents. (5 Pt 1):608-15. Pediatr. 128
• Salo, M. (1992). Effects of anaesthesia and surgery on the immune response. Acta 36(3):201-20. Scand.
• Macpherson, D.S. (1993). Preoperative laboratory testing: should any tests be "routine" before surgery? Med Clin North Am. 77(2):289-308.
• Meneghini, L. et al., (1998). The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children. Paediatr Anaesth. 8(1):11-5.
• Preoperative chest radiographs. (1983). Pediatrics. 71(5):858.
• Von Ungern-Sternberg, B.S. and Habre, W. (2007). Pediatric anesthesia - potential risks and their assessment: part I. Paediatr Anaesth.17(3):206-15.
• Splinter, W.M. and Schreiner, M.S. Preoperative children. Anesth Analg. 89(1):80-9.
• Litman, R.S. Wu C.L. and Quinlivan, J.K. (1994). Gastric volume and pH in infants fed clear liquids and breast milk prior to surgery. Anesth Analg. 79(3): 482-5.
• Splinter, W.M. Stewart, J.A. and Muir, J.G. (1989). The effect of preoperative apple juice on gastric contents, thirst, and hunger in children. Can J Anaesth. 36(1):55-8.
• Splinter, W.M. Stewart, J.A. and Muir, J.G. (1990). Large volumes of apple juice preoperatively do not affect gastric pH and volume in children. Can J Anaesth, 37(1):36-9.