Abstract
Introduction: Preoperative period is a stressful event, especially for paediatric patients undergoing surgery. Stress may lead to the development of perioperative maladaptive behaviour, activation of stress responses, and susceptibility to postoperative infections. To alleviate preoperative stress, the use of a multimodal approach including preoperative pharmacological premedication in the ward is recommended. We conducted an observational study to determine the frequency of prescribing and administering premedication in paediatric surgical patients.Methods: This three-month retrospective observational study was conducted in the main operating room of the Aga Khan University Hospital, Karachi, from October to December 2014. It included all paediatric patients (aged 1-16 years) coming for elective surgery. Patients’ preoperative forms and medical records were reviewed, and data recorded for written orders of premedication and the timing of administration of the premedication drug in the inpatient ward/surgical day care ward. A p-value <0.05 was considered statistically significant.Results: This study included 125 paediatric patients. Premedication was not prescribed to 40% (50/125) patients. In these patients, drug and dose were properly mentioned in 98.7% (74/75) of cases while the route and time of administration were not mentioned in 26.6% and 12% prescription orders, respectively. The premedication drug was administered in 67 out of 75 patients (89.3%) by ward nurses as per prescription. The administration of premedication was documented in 95.5% patients, but the time was missing in 46.3% of cases.Conclusion: A significant number of patients were not prescribed preoperative premedication by the anaesthetist. Moreover, the route and timing of administration of drug were not mentioned especially in cases when premedication was prescribed in the wards.
Highlights
Preoperative period is a stressful event, especially for paediatric patients undergoing surgery
All paediatric patients from the ward or surgical day care (SDC) unit coming for surgery to the main operating room (OR) at Aga Khan University Hospital (AKUH) from 8.00 am to 5.00 pm were included in the study
Premedication prescription Patients undergoing preoperative anaesthesia assessment (N=125) Premedication prescribed by the anaesthetist Name of the drug mentioned in the prescription Dose of drug mentioned in the prescription Route of administration mentioned in the prescription Timing of administration mentioned in the prescription
Summary
Preoperative period is a stressful event, especially for paediatric patients undergoing surgery. Stress may lead to the development of perioperative maladaptive behaviour, activation of stress responses, and susceptibility to postoperative infections. The preoperative period is a stressful event for most individuals undergoing surgery This is especially true in paediatric patients and is related to a limited understanding of the nature of illness and the need for surgery in young children. Almost 50% of children show signs of significant preoperative fear and anxiety that can result in an uncooperative, upset child in the operating/anaesthetic room and can lead to the development of maladaptive behaviour such as emergence delirium, increased postoperative pain, night time crying, new-onset enuresis, separation anxiety, eating disturbances, apathy, withdrawal, and temper tantrums in the post-operative period [1,2,3,4]. Oral midazolam (0.5-0.75 mg/kg, administered 30-60 min before the induction of anaesthesia), with its beneficial effects of anxiolysis, amnesia, and rapid onset of action, is the most commonly used benzodiazepine [2,5,6,7]
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