PREOPERATIVE FASTING TIME:

Neonates have 2 to 3 hourly feeds

Last milk feed - 4 to 6 hours before anaesthesia/ operation
Breast milk: up to 3 hrs before anaesthesia/ operation
Last glucose feed - 2-3 hrs before anaesthesia/ operation

Infants above 4 months & under 1 yr
Last milk feed: up to 6 hrs before anaesthesia
Last clear feed*: (up to 15 ml/kg): up to 4 hrs before anaesthesia/ operation

Children:
Last milk (solid food): up to 6 hrs before anaesthesia/ operation
Last clear feed* (up to 10ml/kg): up to 4 hrs before anaesthesia/operation

*Clear feeds include glucose feeds. Fruit juices without particulate matter. If the child has to be starved longer than the scheduled time, a maintenance drip should be set up to avoid dehydration & hypoglycemia.
If the OT list is unexpectedly delayed or order of cases changed, additional feeds or IV drip should be started.

PREMEDICATION:

The purpose of premedication in the pediatric patient is the same as for adults i.e. to allay anxiety & minimize sections. Not all patients need to be premedicated. Day surgery patients coming for minor surgical procedures generally do not need premedication unless exceptionally anxious. Usually with gentle handling and friendly persuasion, most children can be induced without tears. Children in the kindergarten & school going children can be reasoned with & reasonable rapport can be established especially with parental presence in the induction room. Occasionally, toddlers and those who may have had traumatic previous experiences will need some sedation. E.g. trimeprazine or midazolam.

Trimeprazine: It should be given at least 1 hour before to take effect; the ward should be instructed to give it on time (otherwise, one might have an anxious combative child at induction and a sleepy sedated child in recovery after the procedure, if the sedative is given just before the patient enters the operating theatre).

Patients going for corrective surgery for congenital heart defects will generally need premedication; usually an anti-sialogogue and an opiate. This will depend on the lesion and the planned surgery. These patients will also need an antibiotic cover which can usually be given after IV access, thus avoiding painful IM injections. Some might require oxygen support for transfer.

Patients with airway problems should never be sedated. Those scheduled for microlaryngoscopy & bronchoscopy must receive an atropine for premedication, unless otherwise indicated.

EMLA cream should be applied over dorsum of hand veins in a thick (at least 2mm) layer, 2 cm in diameter and sealed with a transparent, occlusive dressing such as opsite a tegaderm. For EMLA to be effective, it should be in contact with skin for minimum of 30 minutes.