PREMEDICATION AND PREOPERATIVE FASTING IN PEDIATRIC ANESTHESIA - A SURVEY OF CURRENT PRACTICE

This study evaluates the current practice of premedication and preoper ative fasting in pediatric anaesthesia in Germany. A total of 90 quest ionnaires were mailed to randomly selected hospitals with departments or sections of anaesthesiology and pediatric surgery. 71 questionnaire s were returned and analysed (reply rate 79%). 60% of the responding h ospitals start premedication between the ages of 3 and 12 months and 3 2% between 1 and 2 years of age. Premedication ist most often given or ally (64%),followed by rectal (29%) and intranasal (3%) routes. Midazo lam is used by 96% of the respondents as the primary sedative premedic ation. Alternatively, promethazine and chloraldhydrate are most freque ntly used. Anticholinergic drugs are given routinely by 21% of the res pondents. For the apprehensive child intramuscular ketamine is most of ten used (33%), followed by intranasal midazolam (22%), rectal midazol am (19%) and rectal thiopentone or methohexitone (13%). For children l ess than 1 year of age 63% of the hospitals restrict clear liquids 2 h ours and 34% 3 or 4 hours before anaesthesia. 64% of the respondents r equire abstinence from milk for 4 hours and 30% for 6 hours prior to s urgery. For children older than one year of age fasting period require ments for clear liquids were 2 hours (34%), 3 hours (27%),4 hours (30% ) and 6 hours (9%). For children over 1 year of age the majority allow solid food or milk up to 6 hours prior to anaesthesia (68% and 63%, r espectively). The survey shows that premedication is started during th e first two years of age by nearly all responding hospitals. Oral or r ectal midazolam is the most frequently used premedication regimen. Pre operative fasting guidelines vary.