Reducing preoperative anxiety is one of the most important considerations in pediatric surgery. Usually, one parent is invited into the OR suite to comfort the child during the induction process. A study by Kain et al. showed that increased preoperative anxiety in young children is associated with increased postoperative pain and increased analgesic requirements.1 A child's ability to cope with stress mainly depends on his or her developmental age. For example, infants and younger children tend to experience separation anxiety from their parents and stranger anxiety-especially during the perioperative experience. To decrease this anxiety, parents can be taught to physically and verbally soothe the child during the mask induction process. Parents should be encouraged to maintain their composure and to speak to the child calmly and reassuringly.
In most cases, children are induced with an inhaled anesthetic agent via face mask before an I.V. is started. Children should be introduced to the face mask in the preoperative area and shown how to hold it up to the face. This technique is helpful during induction because the child will know what to expect and may feel more in control of the process. Older children and teenagers have more developed verbal communication skills. Because of this, perioperative nurses can speak to the child or teenager about his or her concerns.
Warm it up!
Maintaining normothermia before, during, and after the procedure is another one of the top priorities during pediatric surgery. Complications from hypothermia include excess blood loss, surgical site infection, and longer recovery time.2 Infants are more susceptible to hypothermia than adults because they have a higher ratio of body surface area to weight, which leads to increased heat loss through the skin.3 Active warming devices, such as warming blankets and over bed warmers for newborns, are needed to maintain normal body temperature.2
Weight, weight, weight
When administering medication, the child's weight is more important than age because medication dosages and I.V. fluids are based on the child's weight in kilograms. Adding the child's weight to the "time out" checklist is a useful way to ensure the entire surgical team is aware of the correct weight for medication dosing during the intraoperative period. These medications would include antibiotics as well as local anesthetics.
Parents are also our patients
It is important to remember that parents are also patients. They are the keys to the initial assessment, as they know the child's entire medical history. They can also describe their child's temperament and personality, and can be a powerful ally in implementing a nursing care plan. However, sending a child into surgery is a stressful time for them as well, and therefore, their psychosocial needs are important. Allowing parents ample time to have their questions and concerns addressed is key to establishing their trust in the surgical team and creates an overall sense of satisfaction with the care of their child. A composed parent can help create a calm child in an otherwise emotionally distressing environment.
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