Preparing Your Pediatric Patients and Their Families for the Operating Room: Reducing Fear of the Unknown

Adam C. Adler; Stephanie Leung; Benjamin H. Lee; Scott R. Dubow

doi:10.1542/pir.2017-0011

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Adam C. Adler, MS, MD*,^‡
Stephanie Leung, BS, CCLS^†
Benjamin H. Lee, MD*,^‡
Scott R. Dubow, MD^§

^*Department of Anesthesiology, Perioperative and Pain Medicine and
^†Department of Child Life, Texas Children’s Hospital, Houston, TX
^‡Baylor College of Medicine, Houston, TX
^§Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

AUTHOR DISCLOSURE
Drs Adler, Lee, and Dubow and Ms Leung have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

BiPAP:: bilevel positive airway pressure
CLS:: child life specialist
CPAP:: continuous positive airway pressure
DEA:: Drug Enforcement Administration
IV:: intravenous
MRI:: magnetic resonance imaging
OSA:: obstructive sleep apnea

Education Gaps

Clinicians should: identify the resources available to patients and families to allow for a smooth perioperative experience; understand the long-term effects and potential maladaptive changes associated with an anxiety-provoking perioperative period; understand the most common parental and patient concerns and misconceptions regarding surgery; understand the most common and up-to-date perioperative anesthesia practices; understand the indication for referral to the preoperative anesthesia clinic for patient evaluation to avoid unnecessary cancellation.

Practice Gap

Pediatricians are often tasked with preparing children and their families for the preoperative period and dealing with questions related to postoperative issues and concerns. Instruction based on current practice and new research and techniques may help patients and families cope with the stressors of surgery. Determining which patients may benefit from a medical or child life preoperative visit is of crucial importance.

Objectives

After completing this article, the reader should be able to:

Describe common preoperative anesthesia practice.
Recognize the role of a child life specialist in preparing children for surgery.
Differentiate children who would benefit from a preoperative anesthesia and/or child life evaluation.
Instruct patients and families on issues related to the perioperative period.
Address a wide array of parental concerns regarding surgery, anesthesia, and postoperative pain management.

Introduction

The period of time surrounding a planned surgical procedure can be tumultuous and anxiety provoking for both pediatric patients and their parents. The “mysterious place” that is the operating room often remains a mystery to many health care providers, including those tasked with caring for patients both before and after a procedure. As the health care provider most familiar to patients and their families, the pediatrician is in a …