Preoperative evaluation, premedication, and induction of anesthesia in infants and children.

PURPOSE OF REVIEW Preparation for and induction of anesthesia in children has evolved significantly over the last decade, with particular reference to the reduction of perioperative anxiety reduction by nonpharmacologic and pharmacologic means. Several new large population studies and meta-analyses further scrutinize the current techniques. RECENT FINDINGS Many nonpharmacologic methods to reduce anxiety are effective λU similar to sedative premedications, with the exception of parent present induction of anesthesia. Healthcare providers can be taught to increase anxiety-reducing behaviors through an educational intervention. Clonidine and dexmedetomidine have many similar or superior qualities to midazolam. SUMMARY Larger studies still need to be conducted before wide-scale application of many nonpharmalogical interventions such as parental acupuncture. Similarly, more investigation should be done on outcomes such as onset, emergence, and discharge times, as well as the postoperative response with reference to emergence delirium and postoperative nausea and vomiting prevention to outline the differences among sedative premedications such as midazolam, clonidine, and dexmedetomidine.

综述目的 在过去十年中，儿童麻醉的准备和诱导有了显著发展，特别是在通过非药物和药物手段减少围手术期焦虑方面。几项新的大规模人群研究和荟萃分析进一步审视了当前的技术。 近期发现 许多减轻焦虑的非药物方法是有效的，与镇静类术前用药相似，但家长在场诱导麻醉除外。可以通过教育干预来教导医疗服务提供者增加减轻焦虑的行为。可乐定和右美托咪定与咪达唑仑相比，有许多相似或更优的特性。 总结 在诸如家长针刺等许多非药物干预措施广泛应用之前，仍需要进行更大规模的研究。同样，对于起效时间、苏醒时间和出院时间等结果，以及与苏醒期谵妄和术后恶心呕吐预防相关的术后反应，应该进行更多的研究，以阐明咪达唑仑、可乐定和右美托咪定等镇静类术前用药之间的差异。