Pre-anesthesia assessment

Why are pre-anesthesia assessments helpful?

A pre-anesthesia assessment for your child is an important step to ensure their safety and well-being during surgery. Here is a breakdown of why it is helpful:

1. Review of medical history 
• The assessment allows your health-care team to review your child’s medical history, including any existing health conditions, past surgeries, allergies, or reactions to anesthesia. 
• The PAC team work with your child’s surgical team to get them safely ready for surgery 
• It helps your child’s health-care team understand if there are any underlying issues that could increase the risks associated with anesthesia. 
2. Medication review 
• It is important to provide a list of all medications your child is taking, including prescribed medications, over-the-counter drugs, vitamins, and herbal supplements.
• Some medications or supplements may interact with anesthesia or surgery, so your health-care team requires this information to adjust the anesthesia plan if necessary.
• Herbal medicines and supplements may be a regular part of your child’s usual health routine. However, herbal medicines that are normally safe can cause problems when your child is having surgery under general anesthesia.
• Herbal medicines can be unsafe for children under general anesthesia because they:
• are not regulated, and your health-care provider will not know exactly what is in the medicine
• may increase your child’s risk of bleeding
• may make anesthesia last longer
• may cause low or high blood pressure
• can cause many other side-effects and complications
3. Assessment of risks
• During the pre-anesthesia assessment your child's developmental stage will be considered, and any specific concerns related to their age or condition.
• Children with breathing, heart, or other serious medical issues may need special care when given anesthesia for surgery.
• If your child has a chronic (ongoing) or complex medical condition, it is important to tell your health-care team about their normal health routines and conditions during the pre-anesthesia assessment. You will partner with your child’s health-care team to create a care plan that is best for your child.
• Children with asthma are at higher risk for breathing problems either during or after surgery. If your child has asthma, you can help reduce the risk by making sure their asthma is well managed before the surgery.
• Children with asthma may have the following symptoms:
• wheezing
• coughing
• tightness in the chest
• shortness of breath
• sensitivity to irritants such as cold air, common allergens and second-hand smoke
• If your child has asthma and often has these symptoms, please book an appointment, at least six weeks in advance of surgery, with your child’s primary care provider to try to improve asthma control before their surgery. A change in medicine or a visit to a specialist may be needed.
• It is very important that you bring your child’s puffer and spacer or other medicine to treat symptoms on the day of surgery. Your child should take any prescribed asthma medicines (such as fluticasone ) as usual on the morning of surgery. Even if your child is not experiencing asthma symptoms, they may be asked to take this medicine on the day of the surgery and possibly on the days before surgery as well.
4. Preparation for surgery
• The pre-anesthesia clinic’s team will explain what will happen on the day of surgery.
• You will also be given instructions on how to prepare your child for surgery, such as fasting guidelines (when to stop eating or drinking before surgery) and other preoperative instructions. For more information please see the article "What are the fasting guidelines for your child before surgery".
• Additionally, you will be told what to do if your child gets sick before surgery. For more information please see the page "What to do if your child gets sick before surgery".
5. Laboratory tests and bloodwork
• Depending on your child’s medical history, they may need bloodwork or lab tests prior to surgery. This can help assess overall health and identify any potential issues that might affect the anesthesia.
• Common tests might include blood tests, urine tests, or other screenings, especially if your child has any chronic health conditions.
6. Special considerations for adolescents
• If your child is a female assigned at birth and 12 years or older, or has started menstruating, a urine pregnancy test will be conducted before anesthesia on the day of surgery. This is a standard safety measure to prevent any risks related to anesthesia during pregnancy, even if pregnancy is not expected.
7. Coordination with the entire health-care team
• If your child sees specialists, such as a cardiologist or endocrinologist, the pre-anesthesia assessment clinic will help coordinate care. The clinic may need to contact these providers for additional information or recommendations to ensure safe anesthesia administration.
• If your child would benefit from a Child Life Specialist or additional resources e.g. overnight stay, service dog support, etc. you will work with your child’s health-care team to create a care plan that is best for your child.

The pre-anesthesia assessment helps prepare both your child and your health-care team for surgery, ensuring that your child’s health is optimized for anesthesia, minimizing risks, and answering any questions you may have about your child’s procedure. It's an essential step to ensure a safe and calm experience for your child.

On the day of surgery, you will have an opportunity to ask questions with your child’s health-care team and a more detailed plan will be discussed.