KORESPONDENCE / CORRESPONDENCE Premedication in children: what if it fails? | 53 / Anest intenziv Med. 2025;36(1):52-54 / ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA www.aimjournal.cz Preoperative preparation and education of the child (and parents) according to the possibilities of the department (visit to the operating theatre, games, distraction techniques, educational websites and mobile applications) calm and cooperative child with low preoperative anxiety THE CHILD HAS CALMED DOWN pharmacological deepening of the sedation and of the anxiolysis child uncooperative, severe preoperative anxiety Crisis intervention techniques Induction of general anaesthesia Consider rescheduling the operation Interventions have no effect Sedative premedication Fig. 1. Algorithm for management of preoperative anxiety in children Assessment of the degree of anxiety before the operation (either clinically or by means of scoring systems) PPIA of physical inactivity and unresponsiveness to external stimuli. From an evolutionary perspective, TI is an adaptive response that increases the chance of survival. In humans, TI usually occurs as a result of intense life-threatening events. It is often described in rape victims as “rape paralysis” [7]. It can also occur in children in the operating theatre under conditions of overwhelming stress. From the perspective of crisis intervention, it is important to note that children in the state of tonic immobility have a significant reduction in neocortex activity, hindering their possible cooperation. Preoperative crisis intervention Our intervention aims to reconnect the neocortex, which, in children aged 2–3 years, consists of establishing communication by describing what is happening to them in the operating theatre. The anaesthetist describes the different parts of the child’s body, giving a precise description of what they are doing: “Your little eyes are crying, telling me you don’t want to be here. Your little legs want to run away, they are clever, and they want to run away to a better place. I think they want to play or kick a ball…” It is very important to work with the intonation of the voice to engage the child. Establishing cooperation with older children is usually easy. It is useful to play various games before the induction to general anaesthesia. We try to engage preschoolers with a game of Indians where they imitate the Indian shout loudly while tapping their chest. Asking the child to roar like a tiger makes it easier to insert a venous catheter with the possibility of further pharmacological sedation or induction of anaesthesia.
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