Paediatric Anaesthetic Assessment

Anaesthetic assessment of the paediatric patient aims to:

This covers specific elements of assessing a paediatric patient for anaesthesia. The general elements of the pre-Anaesthetic assessment are covered under Pre-Anaesthetic Assessment, and considerations for paediatric anaesthesia are covered under Considerations in Paediatric Anaesthesia.

History

Particularly important are:

  • Birth and prematurity
  • Respiratory disease

Birth and Prematurity

  • Perinatal events
  • Problems with delivery
  • Prematurity
    • Gestational age at birth
    • Current post-conception age
      Children <56 weeks post-conception age should have pulse oximetry for 12-24 hours post-operatively, due to risk of apnoeas.

Respiratory Disease

  • Asthma
  • Stridor
  • Respiratory tract infection
    Current, or recent (last 6/52).

Respiratory Tract Infection

RTIs are:

  • Defined as two or more of:
    • Sore throat
    • Sneezing
    • Rhinorrhoea
    • Nasal congestion
    • Malaise
    • Cough
    • Fever/laryngitis
  • Usually viral
    May have bacterial superinfection.
  • Commonly described as URTIs, but usually involve whole respiratory tract
  • Associated with ↑ risk of respiratory complications:
    For 6/52 post infection (though highest risk in first 2/52):
    • 5× ↑
    • 10× ↑ if intubated
    • Including:
      • Laryngospasm
      • Coughing
      • Hypoxia
  • Common cause of procedural cancellation

Factors favouring cancellation:

  • Elective surgery
  • Signs of severity
    • Productive cough
    • Purulent secretions
    • Febrile >38°C
    • Systemically unwell
      • Fatigue
      • Anorexia
      • Diarrhoea
      • Vomiting

Factors favouring proceeding:

  • ‘As well as they ever are’
  • Largely recovered
  • Brief surgery
  • Not requiring intubation
  • Continual unwellness
    Many children have multiple RTIs per year, and will never be ‘low risk’.
  • Surgically correctible
    Respiratory symptoms may be due to the lesion requiring surgery.
  • Inconvenience
    Logistical burden on the family may be significant.

Cardiovascular Disease

  • Murmurs
    • Functional and flow murmurs are common in children
      Non-pathological murmurs are:
      • Asymptomatic
      • Soft
      • Systolic
      • Present with normal heart sounds
    • Pathological murmurs are:
      • Symptomatic
        • Failure to thrive
        • Poor exercise tolerance
        • Cyanotic
      • Pansystolic/diastolic
    • Murmurs should be evaluated:
      • Prior to surgery if pathological
      • After surgery if non-pathological (and previously unknown)

References

  1. von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. The Lancet. 2010 Sep;376(9743):773–83.