Premedication and Psychological Preparation

Psychological preparation is probably more important than drug medication when preparing children before anaesthesia and operation.

At the preoperative visit, information should be addressed to the child in the presence of one or both of his parents. The anaesthetist should sit down and listen carefully, being prepared to explain over again serious matters already told but blocked by anxious parents.

Questions regarding parental presence during the induction should be answered in a straightforward manner carrying the conviction that whatever the decision, it will be taken aiming at what is best for the child.

Parental requests to be present during the recovery should always be granted in a paediatric anaesthetic department, and also, if possible, in adult recovery areas receiving the occasional child.

Pharmacological preparation should include a vagolytic drug, preferably atropine, probably best given intravenously at the induction to avoid embarrassing dryness of the mouth. Pain relief, preferably with morphine given slowly intravenously, should always be given if the child suffers from pain preoperatively. Ifhe does not, careful consideration should be given as to what anaesthetic technique will be used and whether spontaneous or controlled ventilation will be preferred, before choosing between morphine or a purely sedative drug or no drug at all besides atropine.