New recommendations from the nation’s leading pediatrics group aim to streamline operative care for children by improving coordination between pediatricians and surgical specialists.

The recommendations, from the American Academy of Pediatrics’ Committee on Practice and Ambulatory Medicine, call for moving beyond the checkbox model of surgical clearance toward a system in which pediatricians provide anesthesiologists and surgeons with more detailed communication about medical and social risks before elective procedures.

Pediatricians should also work with caregivers to implement calming strategies for children to prepare them for the sometimes frightening and/or stressful experience of anesthesia.

Anesthesiologists “want to know that everything that can be done has been done” to prepare the patient for anesthesia, said Rita Agarwal, MD, clinical professor of anesthesiology in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University in Stanford, California, who led the writing of the new report published in Pediatrics.

Pediatricians should identify and clearly communicate risks specific to children with conditions such as cardiac disease, diabetes, and respiratory infections, the latter of which can increase risks for respiratory events during anesthesia.

“Many children present with either respiratory tract infections or respiratory tract infection-induced asthma, particularly in the winter season; having children on a medication regimen that decreases perioperative flare-ups on the day of surgery prevents increased oxygen requirements and hospital admissions following elective surgery,” said Olutoyin Olutoye, MD, MSc, anesthesiologist-in-chief at Ann & Robert H. Lurie Children’s Hospital of Chicago, who was not involved with the new report.

Pediatricians also often have access to detailed medical and social histories that anesthesiologists do not, including recent acute illnesses, prior anesthesia complications, history of prematurity, and medication use. These data can shape risk management and prep for anesthesia.

All medications and therapies a child is receiving should also be clearly communicated to the surgical and anesthesia teams. For instance, surgeons need to know if their patient is on a ketogenic diet for drug-resistant epilepsy so they can avoid using propofol formulations that could disrupt ketosis and trigger breakthrough seizures.

Pediatricians should also tell surgeons if a patient has a condition that would necessitate surgery in an inpatient setting instead of an ambulatory office, such as severe obesity.

“We don’t necessarily need a phone call, but a note in their chart that explains, for example, a particular condition or set of experiences that they’ve had in the past and might affect their experience in the future,” Agarwal said.

Pediatricians may also be aware of factors such as housing circumstances and the ability to afford medications, which should be discussed with anesthesiology teams. Children who live in households where cigarette smoke is present are at risk for being agitated and confused when awakening from anesthesia. But this information is not always relayed, Olutoye said.

Brian Johnston, MD, MPH, chief of pediatrics at Harborview Medical Center in Seattle, said the guidance describes the “way we wish the system worked, rather than the way it actually works for a lot of community and private‑practice pediatricians.”

Johnston, who was not involved with writing the document, said meeting the guidance would require reviewing prior records, assessing individual risk, coordinating with subspecialists, and counseling families.

“Most community visits are already compressed, and payment rarely reflects that extra cognitive and coordination work,” he said.

Barriers to implementation also include fragmented communication channels between pediatricians and freestanding surgery centers or dental clinics and electronic referral processes built around clearance-style checklists rather than detailed, context-rich information. Families may also prefer the earliest available surgery, even when the guidelines would suggest delaying the procedure, such as when a child has symptoms from a recent concussion.

Agarwal said not all suggestions can be realistically undertaken, but “we just want the child to be as well managed as possible before we subject them to anesthesia.”

No external funding was obtained for the report. The sources cited in this article report no disclosures.