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  1. Past medical history with emphasis on prior anesthetic experiences and familial disorders (ie, bleeding, malignant hyperthermia, hemoglobinopathies) should be explored during the preoperative visit.

  2. Fasting guidelines have been modified to allow for the age of the child and for clear liquids up to 2 hours prior to general anesthesia.

  3. In general, children with chronic disorders should take their medications on the day of surgery (exceptions are diuretics, antihypertensives).

  4. Asthma is the leading cause of chronic illness in children; specific questions such as history of emergency department visits, recent oral or intravenous steroid use, and hospitalizations should be inquired during the preanesthetic period.

  5. Sleep-disordered breathing (SDB) affects about 10% of the population with about 1% to 4% progressing to obstructive sleep apnea syndrome (OSAS).

  6. Children with cold symptoms have an increased risk for perioperative complications such as atelectasis, bronchospasm, laryngospasm, and postoperative pneumonia.

  7. Former premature infants are at risk for postanesthetic apnea especially if the hematocrit is less than 30%.

  8. Children with history of congenital heart disease should have the most updated cardiology note and procedures (ECG, Echo, cardiac catheterization, CXR) documented in the chart prior to any anesthetic administration.

There is an increasing desire among patients and families to be involved in the perioperative decision-making process.1 Informed consent in pediatric surgical and interventional procedures requiring general anesthesia involves a shared decision-making process between the multidisciplinary physicians, patient, and family. Shared decision making has the potential to increase satisfaction with care, reduce decisional conflict and regret, improve understanding of and participation in care, and thereby improve health-related quality of life. It is important that the anesthesiologist should be able to accurately estimate and describe the risks of the proposed anesthetic management to the family. Pediatric risk assessment tools may be used to communicate these patient-specific risks.2

Anesthetic risk can be decreased by maximizing the information known about the patient’s health prior to induction of anesthesia. The overall incidence of cardiac arrest in children under 18 years of age has been reported to be 2.9–4.95/10,000 and of these 18.28/10,000 or 0.18% were below 1 year of age.3 Since there is no substitute for the long-term relationship that pediatrician, family, and patient have, it is the responsibility of the perioperative anesthesia care team to assess the patient’s current health status as it compares with the usual state of health. Both acute and chronic diseases should be evaluated and optimized prior to anesthesia. The choice of anesthetic agent and mode of delivery is a multifactorial decision; however, state of health, both current and prior, is the major determinant. Appropriate laboratory examination should be performed prior to the time of surgery to provide adequate opportunity to adjust or optimize a patient’s current health status. If consultation by another specialist is warranted, this can be planned and accomplished prior to anesthesia and surgery. Not only will this planning optimize anesthetic risk factors, but will also prevent ...

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