PROCJENA PRIJEANESTEZIJSKOG RIZIKA U DJECE

Ivana Bureš, Ljiljana Popović

Prijeoperacijska procjena zdravstvenog stanja bolesnika neizostavni je dio planiranja svakog zahvata pri kojemu se bolesnik podvrgava anesteziji. Klasifikacija fizikalnog statusa bolesnika Američkog društva anesteziologa (engl. The American Society of Anesthesiologists – ASA) danas se rutinski rabi za procjenu rizika od anestezije i perioperacijske smrtnosti bolesnika neovisno o dobi. Međutim, kao što se anestezija u djece razlikuje od anestezije u odraslih, nužno je i u prijeanestezijskoj procjeni rizika uzeti u obzir osobitosti dječje dobi. Radi kvalitetne procjene rizika od anestezije razvili su se novi sustavi procjene rizika i specifične smjernice prijeanestezijske obrade u djece. Ukratko su prikazana dva nova alata za procjenu prijeanestezijskog rizika u djece: bodovni sustav PRAm (Pediatric Risk Assessment score) i sustav NARCO-SS (engl. neurological, airway, respiratory, cardiovascular, other-surgical severity). Cilj je rada kritički osvrt na postojeće smjernice procjene prijeanestezijskog rizika u djece. Prijeoperacijskom procjenom rizika i pripremom za anesteziju prilagođenom dječjoj dobi mogu se unaprijediti sigurnost i uspjeh anesteziološkog postupka u djece.

The preoperative assessment of the patient’s health status is an indispensable part of planning any procedure where the patient is undergoing anesthesia. The American Society of Anesthesiologists’ Physical Status (ASA PS) classification is routinely used today to assess the risks of anesthesia and perioperative mortality of patients undergoing surgery regardless of age. However, as anesthesia in children differs from anesthesia in adults, it is necessary to take into account the age-specific features of preoperative risk assessment in children.For better estimation of risks of anesthesia, new risk assessment systems and specific pre-anesthetic treatment guidelines for children have been developed. Two novel tools for assessing the preanesthetic risk in children are briefly presented: Pediatric Risk Assessment (PRAm) score and “NARCO-SS” (neurological, airway, respiratory, cardiovascular, other – surgical severity) score. The aim of this paper is critical review of existing guidelines in assessing the preoperative risk in children. The preoperative risk assessment and the preparation for anesthesia adapted to the child’s age can improve the safety and success of the anesthetic procedure.