Current Anesthesiology Reports

, Volume 9, Issue 3, pp 333–339 | Cite as

Pediatric Palliative Care in the Perioperative Period

  • Nancy L. GlassEmail author
Pediatric Anesthesia (J Lerman, Section Editor)
Part of the following topical collections:
  1. Pediatric Anesthesia


Purpose of Review

The purpose of this review is to familiarize anesthesiologists with the role of the subspecialty of pediatric palliative care and its potential contributions to the management of children with complex and life-threatening illnesses, many of whom may present for operative or diagnostic procedures requiring anesthesia.

Recent Findings

Recent publications highlight the benefits of palliative care to patients and families experiencing a wide variety of conditions along the continuum from prenatal application to the management of young adults. Retrospective reports highlight improved quality of life, improved symptom control, an impact on place of care, and an increased rate of achieving the preferred place of death.


Pediatric palliative care is a relatively new subspecialty of pediatrics which utilizes an interdisciplinary team approach to support patients and their families undergoing treatment for life-threatening or life-limiting conditions, addressing physical, emotional, and psychological needs to care for the whole patient.


Pediatric palliative care and hospice Perioperative palliative care Advanced care planning Goals of care Life-threatening illness DNR orders 


Compliance with Ethical Standards

Conflict of Interest

Nancy L. Glass declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kelley A, Morrison RS. Palliative care for the seriously ill. N Engl J Med. 2015;373:747–55.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Section on Hospice and Palliative Medicine and Committee on Hospital Care. Pediatric palliative care and hospice care commitments, guidelines, and recommendation. Pediatrics. 2013;132:966–72.CrossRefGoogle Scholar
  3. 3.
    Harding R, Wolfe J, Baker JN. Outcome measurement for children and young people. J Palliat Med. 2017;20:313.CrossRefGoogle Scholar
  4. 4.
    The District of Columbia Pediatric Palliative Care Collaborative and the National Hospice and Palliative Care Organization (2012) Concurrent care for children requirement: implementation toolkit.Google Scholar
  5. 5.
    Weaver M, Carter BS, Keefer P, Korones DN, Miller EG. Pediatric palliative care and hospice, 5th ed. Chicago: American Academy of Hospice and Palliative Medicine; 2017.Google Scholar
  6. 6.
    • Davies B, Brenner P, Orloff S, Sumner L, Worden W. Addressing spirituality in pediatric hospice and palliative care. J Palliat Care. 2002;18:59–67 Although this article came out in 2002, it provides an excellent description of spirituality for clinicians, and suggests a group of open-ended questions to engage patients and family members in a discussion of life, death, and spirituality.CrossRefGoogle Scholar
  7. 7.
    Edlynn E, Kaur H. The role of psychology in palliative care. J Palliat Med. 2016;19:760–2.CrossRefGoogle Scholar
  8. 8.
    Boyden JY, Curley MAQ, Deatrick JA, Ersek M. Factors associated with the use of US community-based palliative care for children with life-limiting or life-threatening illnesses and their families: an integrative review. J Pain Symptom Manag. 2018;55:117–31.CrossRefGoogle Scholar
  9. 9.
    •• Moore D, Sheetz J. Pediatric palliative care consultation. Pediatr Clin N Am. 2014;61:735–47 This is a terrific overview of a palliative care consultation: when to consult, how to introduce the palliative care team, and what to expect from the consultation.CrossRefGoogle Scholar
  10. 10.
    Marc-Aurele KL, English NK. Primary palliative care in neonatal intensive care. Semin Perinatol. 2017;41:133–9.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Carter BS. More than medication: perinatal palliative care. Acta Paediatr. 2016;105:1255–6.CrossRefGoogle Scholar
  12. 12.
    • Madden K, Wolfe J, Collura C. Pediatric palliative care in the intensive care unit. Crit Care Nurs Clin N Am. 2013;27:341–54 This paper discusses primary palliative care of infants and children in NICUs and PICUs, reviews communication challenges, symptom management, ethical issues, and advanced care planning, and suggests when specialist palliative care should be incorporated into management.CrossRefGoogle Scholar
  13. 13.
    Jones PM, Carter BS. Pediatric palliative care: feedback from the pediatric intensivist community. Am J Hosp Palliat Med. 2010;27:450–5.CrossRefGoogle Scholar
  14. 14.
    Atwood MA, Hoffman RG, Yan K, Lee KJ. Attitudes about palliative care: a comparison of pediatric critical care and oncology providers. Am J Hosp Palliat Med. 2013;31:665–71.CrossRefGoogle Scholar
  15. 15.
    Weaver M, Heinze KE, Kelly KP, Wiener L, et al. Palliative care as a standard of care in pediatric oncology. Pediatr Blood Cancer. 2015;62:S829–33.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Kaye EC, Friebert S, Baker JN. Early integration of palliative care for children with high-risk cancer and their families. Pediatr Blood Cancer. 2016;63:593–7.CrossRefGoogle Scholar
  17. 17.
    Humphrey L, Kang TI. Palliative care in pediatric patients with hematologic malignancies. Hematology. 2015;2015:490–5.CrossRefGoogle Scholar
  18. 18.
    • Hauer JM, Wolfe J. Supportive and palliative care of children with metabolic and neurological diseases. Curr Opin Support Palliat Care. 2014;8:296–302 This paper reviews the special challenges of caring for metabolically or neurologically impaired children, whose symptoms may be particularly hard to manage, and whose prognosis may be extremely difficult to predict; the authors advocate for the role of palliative care to assist both families and practitioners.CrossRefGoogle Scholar
  19. 19.
    Tamburro R, Shaffer M, Hahnlen N, et al. Care goals and decisions for children referred to a pediatric palliative care program. J Palliat Med. 2011;14:607–13.CrossRefGoogle Scholar
  20. 20.
    • Fowler A, Freiburger D, Moonan M. Palliative and end of life care in pediatric solid organ transplantation. Pediatr Transplant. 2014;19:11–7 The authors highlight the unique care needs of potential transplant recipients and their families, threats to quality of life before and after transplant, and issues surrounding compliance and re-transplant. Barriers to incorporating palliative care for this complex patient cohort includes the physician sense that transplantation and palliative care have “contradictory” goals.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Coleman R, Curtis J, Nelson J, et al. Barriers to optimal palliative care of lung transplant candidates. Chest. 2013;143:736–43.CrossRefGoogle Scholar
  22. 22.
    Keefer P, Lehmann K, Shanley M, Woloszyk T, Khang E, Luckritz K, et al. Single-center experience providing palliative care to pediatric patients with end-stage renal disease. J Palliat Med. 2017;20:845–9.CrossRefGoogle Scholar
  23. 23.
    • Clark JK, Fascino K. Young Adult Palliative Care: Challenges and opportunities. Am J Hosp Palliat Med. 2013;32:101–11 This article addresses an underserved patient population: young adult survivors of congenital or pediatric conditions. The authors discuss the physical and emotional challenges facing these patients and demonstrate both the challenges and opportunities for palliative care to make a contribution to their care.CrossRefGoogle Scholar
  24. 24.
    Sanderson A, Hall AM, Wolfe J. Advance care discussions: pediatric clinician preparedness and practices. J Pain Symptom Manag. 2016;51:520–8.CrossRefGoogle Scholar
  25. 25.
    Feudtner C, Blinman TA. The pediatric surgeon and palliative care. Semin Pediatr Surg. 2013;22:154–60.CrossRefGoogle Scholar
  26. 26.
    •• Brown SES, Antiel RM, Blinman TA, Shaw S, Neuman MD, Feudtner C (2019) Pediatric perioperative DNR orders: a case series in a children’s hospital. J Pain Symptom Manag. This paper provides an excellent overview of the varied ways in which DNR orders are handled in the perioperative period, highlights gaps in communication and documentation, and offers suggestions for improving how DNR status is discussed and documented for patients presenting to the operating room. Google Scholar
  27. 27.
    • Robins B, Booser A, Lantos JD. When parents have misunderstandings about the risks and benefits of palliative surgery. Pediatrics. 2018;142:e20180482 Lantos and colleagues remind us that it is often anesthesiologists who realize that parents may not understand the risks and benefits of palliative surgical procedures, creating moral distress for the anesthesiologist. They advocate for anesthesiology participation in the decision-making process.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Baylor College of Medicine and Texas Children’s HospitalHoustonUSA
  2. 2.Palliative Care ServiceTexas Children’s HospitalHoustonUSA

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