"Clear for surgery": current attitudes and practices of pediatricians

Two thousand five hundred pediatricians, constituting 10% of active, US-based members of the American Academy of Pediatrics, were randomly selected to receive a survey of attitudes and practices in the preoperative evaluation of children, and communication with anesthesiologists. Of the 790 respondents, 30% routinely examine children prior to elective surgery at present, although 60% felt they should ideally do so. Only 7.6% had training contacts with anesthesia during residency, and only 17% felt their expertise was appreciated by the operating team in preparing children for surgery. In clinical management situations, most agreed on the anesthetic risks of a recent-onset upper respiratory infection, but varied in assessing the risks to a growing premature infant, of a patient with Trisomy 21, or of an asthmatic on chronic theophylline. The results suggest that pediatricians see their role as important in preoperative preparation of children, but lack appropriate training and experience. If "clear for surgery" is to be a meaningful activity, greater communication between anesthesiologists and pediatricians must be developed.