Opioid-induced postinfusion hyperalgesia could be abolished by S-ketamine, suggesting an N-methyl-d-aspartate-receptor mechanism. In contrast, elevated pain ratings after infusion were not reduced by ketamine but were alleviated by the alpha(2)-receptor agonist clonidine. The results of this study suggest different mechanisms of opioid-induced postinfusion antianalgesia and secondary hyperalgesia.

Outpatient anesthesia care for children undergoing smaller surgery may offer advantages when the conditions are optimized. The overall competence of the institution in addition to the qualifications of the anesthesiologist is crucial for a high quality result. This includes standardized approaches for perioperative management (premedication, pain therapy, PONV prophylaxis, postoperative monitoring etc.), facilities with age adjusted equipment, medical staff with experience in the care of children, regular training of emergency situations in the team and clear concepts for the postoperative care.