The Influence of Anesthesia On Perioperative Outcome in Children - Institutional and Individual Factors

Abstract

The perioperative care of children is challenging for health care providers. Since anesthetists cannot affect the nature of the disease and have hardly an impact on the decision for surgery we summarized in this review individual and institutional factors for improving perioperative outcome by anesthetists. Individual factors include the level of education and the professional experience of the anesthetist as well as an anesthetic management that is focused on the maintenance of an adequate cerebral perfusion. Besides individual factors this review emphasizes the importance of institutional factors as measures to reduce anxiety and insecurity of the parents which result in less distress and coping of the children in the postanesthesia care unit as well as less need for pain medication, less emergence delirium and less sleep disorders. A behaviorally oriented preoperative preparation of parents and children also affects the postoperative course of the pediatric patients positively as well as institutional concepts for the reduction of perioperative medication errors and adverse drug events. We believe that perspectively pediatric surgery will be increasingly performed in high volume hospitals which are able to guarantee beneficial institutional structures as well as a high educational level and high professional experience of the employed anesthetists.