SummaryBackground: Taking heed of patient preferences is central to the concept of "patient-centered anesthetic practice'. Anesthesia in children is usually induced by the inhaled or intravenous routes. We hypothesized that children may have preferences for their route of induction of anesthesia, and for preoperative sedation. Accordingly, we audited the preferences and compliance of children for inhalational or intravenous induction of anesthesia and for premedication.
Methods:With institutional approval and guardian consent, one hundred and seventeen children and their guardians were visited pre-operatively. The opinions of the child (primarily) and guardian (secondarily) were canvassed, in standard fashion, regarding choice of route for anaesthetic induction and request for premedication.Results: Eight children <2 years of age were unable to communicate, all children >5 years and older were able to communicate, as were 1 of 6 two year olds, 1of 6 three year olds and 5 of 6 four year olds. Parental recommendations occurred in 14(12%) of children. Fifty eight (50%) children had histories of previous anesthesia, induced by needle in 23 (20%), mask in 32(57%) and by undetermined route in 14 (24%). Intravenous and inhaled inductions were chosen by 23(20%) and 62 (53%) of children (p<0.0005), with 10(9%) and 22(19%) children either expressing no preference or being unable to choose. Of 23 children initially selecting injection, 10(44%) subsequently changed their choice to inhalation, and of those initially selecting inhalation one patient subsequently chose injection. In actuality, 14(12%) and 103(88%) children were induced by needle and mask, respectively (p<0.0005). Premedication was requested by 64(55%) children.
Conclusion:These data suggest that children as young as two years of age may have an opinion and that children >5 years can be expected to have an opinion regarding their route for induction of anaesthesia, and that approximately 50% of children accept an offer of premedication.
