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Pediatric patients presenting for surgery are unique not only in their physiology but also in their emotional maturity compared to adults. The pediatric anesthesiologist must be able to effectively manage the spectrum of emotional responses that children of varying ages may have during the perioperative period. A careful preoperative evaluation of the patient may help in developing a rapport with both the parents and the child and may diminish the anxiety associated with surgery. This anxiety often stems from the patient’s fear of needles, parental separation, surgical pain, and thoughts of disfigurement after surgery. Preoperative anxiety is not only an unpleasant emotional experience for the patient but can have physiologic implications that may complicate induction and recovery from anesthesia. Although further research is still warranted, it has been suggested that higher preoperative anxiety levels may increase heart rate, blood pressure, and incidences of laryngospasm, pain, and emergence delirium. Premedication has been shown to reduce psychological trauma and anesthetic risk by inducing anxiolysis, increasing patient cooperation, and decreasing cardiovascular lability.

When weighing the decision to premedicate, one must consider concomitant administration of medications for purposes other than anxiolysis, including medications for the prevention of bronchospasm and decreasing gastric acidity. This may affect timing and the chosen route of premedication for anxiolysis. An ideal premedication agent is effective in relieving anxiety, has minimal hemodynamic effects, is easily administered, has a quick onset but does not delay recovery from anesthesia, and has a predictable (and nonparadoxical) response in any given patient (Table 125-1).

TABLE 125-1Commonly Used Pediatric Premedications

That being said, not all patients require premedication. In general, infants and neonates under 8 months of age usually do not ...

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