Fig. 4.1 The figure shows, on the left-hand scale, the approximate frequency with
which a particular pain control technique is used, and on the bottom scale the
increasing degree of physiological intrusion from local analgesia, through sedation to
general anaesthesia.
4.6 MEDICAL STATUS
The wide variety of medical problems makes it difficult to be precise about the
management strategy appropriate for each patient. Detailed descriptions of
management of a variety of medical problems appear in a comprehensive book by
Scully and Cawson (1998). With regard to sedation, the American Society of
Anesthesiologists' (ASA) classification provides an excellent guide to the type of
sedation or anaesthesia appropriate to an individual patient's medical and behavioural
problems (Table 4.2).
The decision as to whether a patient should be treated under general anaesthesia or
local anaesthesia, or local anaesthesia with sedation depends on a combination of
factors, the most important of which are:
(1) the age of the child;
(2) the degree of surgical trauma involved;
(3) the perceived anxiety and how the patient may (or has) responded to similar levels
of surgical trauma;
(4) the complexity of the operative procedure;
(5) the medical status of the child.
There are no hard and fast rules, and every procedure in every child must be assessed
individually and the different elements considered in collaboration with the parent