Preoperative evaluation in infants and children: recommendations of the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI)

A B S T R A C TBackground. The preoperative assessment involves the process of evaluating the patient’s clinical condition, whichis intended to define the physical status classification, eligibility for anesthesia and the risks associated with it, thusproviding elements to select the most appropriate and individualized anesthetic plan. The aim of this recommendationwas provide a framework reference for the preoperative evaluation assessment of pediatric patients undergoingelective surgery or diagnostic/therapeutic procedures.Methods. We obtained evidence concerning pediatric preoperative evaluation from a systematic search of the electronicdatabases MEDLINE and Embase between January 1998 and February 2012. We used the format developedby the Italian Center for Evaluation of the Effectiveness of Health Care’s scoring system for assessing the level ofevidence and strength of recommendations.Results. We produce a set of consensus guidelines on the preoperative assessment and on the request for preoperativetests. A review of the existing literature supporting these recommendations is provided. In reaching consensus,emphasis was placed on the level of evidence, clinical relevance and the risk/benefit ratio.Conclusion. Preoperative evaluation is mandatory before any diagnostic or therapeutic procedure that requires theuse of anesthesia or sedation. The systematic prescription of complementary tests in children should be abandoned,and replaced by a selective and rational prescription, based on the patient history and clinical examination performedduring the preoperative evaluation. (Minerva Anestesiol 2014;80:461-9)Key words: Child - Ambulatory care - Blood coagulation - Preoperative period - Anesthesia