- •
Risk stratification is important to determine when it is safe to proceed with anesthesia in a child with current or recent upper respiratory infection.
- •
Patients at risk of apnea should be admitted for overnight monitoring; these include former premature infants younger than 55 to 60 weeks postconceptual age, full-term infants younger than 44 weeks postconceptual age who demonstrate any respiratory abnormalities, and certain children with sleep apnea who are recovering from tonsillectomy.
- •
In
Pediatric Ambulatory Anesthesia
Section snippets
Key points
Patient selection
Appropriate patient selection is critical to the success of outpatient surgery. Special areas of concern with children presenting for ambulatory anesthesia include upper respiratory tract infection (URI), apnea risk (among infants and those with sleep apnea), cardiac disease, and undiagnosed myopathy. The facility and expertise of available staff must also be considered in selecting younger or higher-risk children for outpatient surgery.
Nonpharmacological Anxiolysis
Anxiolytic premedication may be problematic in a rapid-turnover ambulatory surgery setting. For example, midazolam may delay recovery and discharge, whereas clonidine may require a lengthy onset time.51, 52 There are several nonpharmacological techniques to reduce preoperative anxiety, including professional entertainers (eg, clowns and magicians), audiovisual material (eg, videos, games, music), verbal techniques (eg, humor and distraction), and parental presence during the induction of
Intubation Without Neuromuscular Blockade: Remifentanil
Tracheal intubation without neuromuscular blockade (NMB) has become increasingly common in pediatric anesthesia,67 even though NMB use may actually be associated with lower PRAE risk.14 In the ambulatory surgical setting, there are several reasons to avoid NMB: there are no truly short-acting nondepolarizers; emergence may be delayed if the NMB is not reversible in time; and incomplete NMB reversal may produce subtle findings such as difficulty swallowing and visual changes, which delay street
Summary
Ambulatory anesthesia is safe for a variety of procedures in the pediatric population with careful attention to patient selection. Respiratory concerns include identifying significant upper respiratory infection, and ensuring appropriate overnight monitoring for patients at risk of apnea (ie, former premature infants or patients with significant OSA). Patients with muscular dystrophy or mitochondrial disorders must be evaluated carefully and drugs chosen to minimize the impact of anesthesia on
References (127)
- et al.
Challenges in pediatric ambulatory anesthesia: kids are different
Anesthesiol Clin
(2010) - et al.
Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study
Lancet
(2010) - et al.
The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit?
J Pediatr Surg
(2008) - et al.
Overnight observation in former premature infants undergoing inguinal hernia repair
J Pediatr Surg
(2012) - et al.
King-Denborough syndrome with and without mutations in the skeletal muscle ryanodine receptor (RYR1) gene
Neuromuscul Disord
(2011) - et al.
Muscular dystrophies
Lancet
(2013) - et al.
Early stages of propofol infusion syndrome in paediatric cardiac surgery: two cases in adolescent girls
Br J Anaesth
(2008) - et al.
Impaired fatty acid oxidation in propofol infusion syndrome
Lancet
(2001) - et al.
Mitochondrial disorders and general anaesthesia: a case series and review
Br J Anaesth
(2008) Presentation and diagnosis of mitochondrial disorders in children
Pediatr Neurol
(2008)
The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade
J Clin Anesth
The effect of propofol/remifentanil rapid-induction technique without muscle relaxants on intraocular pressure
J Clin Anesth
Assessment of pain and hemodynamic response in older children undergoing circumcision: comparison of eutectic lidocaine/prilocaine cream and dorsal penile nerve block
J Pediatr Urol
Patient selection in ambulatory anesthesia—an evidence-based review: part II
Can J Anaesth
Patient selection in ambulatory anesthesia—an evidence-based review: part I
Can J Anaesth
High risk patients in day surgery
Minerva Anestesiol
Ambulatory surgery in the United States, 2006
Natl Health Stat Report
Anesthesia for the child with an upper respiratory tract infection: still a dilemma?
Anesth Analg
Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections
Anesthesiology
Risk factors for adverse events in children with colds emerging from anesthesia: a logistic regression
Paediatr Anaesth
Anesthesia in children with a cold
Curr Opin Anaesthesiol
Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections
Anesthesiology
Clinical predictors of anaesthetic complications in children with respiratory tract infections
Paediatr Anaesth
Topical lidocaine reduces the risk of perioperative airway complications in children with upper respiratory tract infections
Can J Anaesth
Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery
Paediatr Anaesth
Upper respiratory tract infections and general anaesthesia in children. Peri-operative complications and oxygen saturation
Anaesthesia
Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis
Anesthesiology
Postoperative apnea in a full-term infant
Anesthesiology
Postoperative apnea in a full-term infant with a demonstrable respiratory pattern abnormality
Anesthesiology
Postoperative apnea in a full-term infant
Anesthesiology
Can a dose of 2microg.kg(-1) caudal clonidine cause respiratory depression in neonates?
Paediatr Anaesth
Ambulatory pediatric otolaryngologic procedures in the United States: characteristics and perioperative safety
Laryngoscope
Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children
Otolaryngol Head Neck Surg
Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates
Anesthesiology
Risk factors for desaturation after tonsillectomy: analysis of 4092 consecutive pediatric cases
Laryngoscope
Mortality and major morbidity after tonsillectomy: etiologic Factors and Strategies for Prevention
Laryngoscope
Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: Houston, we have a problem!
Anesth Analg
FDA: no codeine after tonsillectomy for children
JAMA
Anesthesia-related cardiac arrest in children: update from the Pediatric Perioperative Cardiac Arrest Registry
Anesth Analg
Succinylcholine-induced cardiac arrest in children with undiagnosed myopathy
Can J Anaesth
Case scenario: hypotonia in infancy: anesthetic dilemma
Anesthesiology
The risk of malignant hyperthermia in children undergoing muscle biopsy for suspected neuromuscular disorder
Paediatr Anaesth
Core myopathies and risk of malignant hyperthermia
Anesth Analg
Activated charcoal effectively removes inhaled anesthetics from modern anesthesia machines
Anesth Analg
The postoperative cardiovascular arrest of a 5-year-old male: an initial presentation of Duchenne's muscular dystrophy
Paediatr Anaesth
Muscular dystrophy, anesthesia and the safety of inhalational agents revisited; again
Paediatr Anaesth
Anesthesia and Duchenne or Becker muscular dystrophy: review of 117 anesthetic exposures
Paediatr Anaesth
Malignant hyperthermia and muscular dystrophies
Anesth Analg
Propofol infusion syndrome
Anaesthesia
Anesthetic considerations in patients with mitochondrial defects
Paediatr Anaesth
Cited by (20)
Pharmacokinetics and Pharmacology of Drugs Used in Children
2019, A Practice of Anesthesia for Infants and ChildrenPediatric Review and Perioperative Considerations
2018, Journal of Perianesthesia NursingCitation Excerpt :The most common perioperative respiratory adverse events associated with upper respiratory infections include laryngospasm, bronchospasm, atelectasis, coughing, stridor, and airway obstruction.19 Pediatric patients at risk for postanesthetic apnea, particularly infants, should be identified, and preparations need to be made for overnight observation.20 Similar to the respiratory evaluation, the preoperative cardiac evaluation should pay particular attention to congenital defects, intracardiac shunts, and murmurs.
Pharmacokinetics and Pharmacology of Drugs Used in Children
2018, A Practice of Anesthesia for Infants and ChildrenOutpatient Pediatric Orthopedic Surgery
2018, Orthopedic Clinics of North AmericaCitation Excerpt :In light of this, there has been an evolving focus on outpatient procedures in many orthopedic interventions over the past 30 years.1,2 Although most prevalent in adult orthopedic surgery, this trend has been observed in the pediatric population as well.3,4 As experience with outpatient surgery increases, selection criteria has widened.5
Improving Surgical Delays Related to Pediatric Preoperative Pregnancy Testing: A Quality Improvement Project
2023, Journal of Pediatric Surgical NursingAnalgesic strategies for children’s ambulatory surgery
2022, Revista Chilena de Anestesia
Disclosure: Neither author is affiliated with companies that have a direct or competing financial interest in the material discussed in this article.