Preinduction techniques for pediatric anesthesia

Purpose of review: Preparing pediatric patients for their surgical experience is a complex process that may be facilitated by pharmacologic and non-pharmacologic techniques. Several techniques often utilized in the preoperative setting decrease the anxiety level of pediatric patients and their parents include the administration of a sedative premedicant, parental presence during induction, and a variety of other non-pharmacologic modalities. These techniques may be useful, alone or in combination, to decrease anxiety levels in children and parents. This article review the most recent literature available on a variety of preinduction techniques in children. Recent findings: Recent studies have evaluated various pharmacologic and non-pharmacologic preinduction techniques in children. Preoperative administration of midozalam, alone or combined with other pharmacologic agents, is the most effective technique at reducing anxiety in the child and parent. Although the literature supports the use of non-pharmacologic preinduction techniques, these modalities are time consuming, expensive, and do not consistently modalities are typically combined with pharmacologic premedicants. Summary: Although a variety of preinduction techniques exist, the most popular technique involves administering a sedative premedication, such as midozalam. Administering a premedicant will reliably decrease anxiety, improve cooperation during induction, and improve parental satisfaction. In addition, other preinduction strategies such as aprental presence during induction may play a role in reducing anxiety levels in select children and their parents, and should be considered.