Peri-operative care of paediatric patients presents unique challenges and opportunities for surgeons and anaesthetists to work synergistically. No subpopulation of patients is more heterogeneous with respect to physiology or spectrum of pathology.

Pre-operative

Having decided that the child before them requires an operation, surgeons must consider a number of areas peculiar to paediatric patients.

Need for general anaesthesia

Many procedures that would be done in adults under local anaesthesia, or with conscious sedation, cannot be achieved without general anaesthesia in children. Examples include MR imaging studies, GI endoscopies and most minor body surface surgery.

Assessment and optimisation

Most elective procedures in children are performed on a day case basis. Prudent selection and referral of patients who require pre-operative anaesthetic assessment for optimisation is critical, to avoid both unnecessary additional hospital visits and day of surgery cancellations.

Planned pre-operative admission

This is an indication for a detailed pre-operative anaesthesia assessment. The admission is likely a function of some combination of the magnitude of surgery, existing co-morbidity and the need for advanced post-op pain management modalities. Adequate time needs to be provided for optimisation of co-morbidities, and for the risks and benefits of anaesthesia and post-op pain management strategies to be presented and digested by the patient and family.