Challenges in Pediatric Ambulatory Anesthesia: Kids are Different

Collins, Corey; Everett, Lucinda L.

doi:10.1016/j.anclin.2010.02.005

Cited by 19 publications

(10 citation statements)

References 87 publications

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“…It must be remembered that until the age of five the anatomy of the child's airway is naturally different the adult's. The tongue is big, the larynx is funnel-shaped, the subglottic regionis the narrowest section, the epiglottis is long, the trachea and bronchi have high airway resistance, the intercostal muscles are poorly developed and the diaphragm is the main respiratory muscle [14]. The Mallampati classification and direct laryngoscopy are good and useful tests predicting difficulties in maintaining normal airway patency (Table I) [13].…”

Section: Premedication Visit Risk Assessment During the Sedation Of mentioning

confidence: 99%

Procedural sedation and analgesia in children undergoing digestive endoscopic procedures – paediatrician or anaesthesiologist?

Bartkowska-Śniatkowska¹,

Rosada-Kurasińska²,

Ignyś³

et al. 2014

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Endoscopic procedures of the gastrointestinal tract were successfully introduced into paediatric practice in the 1970s. Recent expansive development has become useful for improvement of both diagnosis and treatment in many children with gastrointestinal diseases. Most of these procedures are performed under procedural sedation (PSA) knowing anatomical, physiological and psychological differences and requiring good experience from the paediatrician and anaesthesiologist. These principles help to provide the procedure safely and minimise adverse events, which are greater the smaller the child is. Procedural sedation and analgesia in healthy children can be performed by a paediatrician, but children with congenital defects and serious coexisting diseases (ASA ≥ III) and also during the usage of anaesthetics (e.g. propofol), should be managed by an anaesthesiologist.

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Section: Premedication Visit Risk Assessment During the Sedation Of mentioning

confidence: 99%

Procedural sedation and analgesia in children undergoing digestive endoscopic procedures – paediatrician or anaesthesiologist?

Bartkowska-Śniatkowska¹,

Rosada-Kurasińska²,

Ignyś³

et al. 2014

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“…Respiratory complications are prevalent in preterm infants, children with upper respiratory tract infection (URI), and those diagnosed with OSA. 17 In preterm infants, apneic spells longer than 15-20 seconds can be observed, and are often associated with desaturation and bradycardia. Such apneic episodes increase in frequency during stressful situations, which would of course include the postsurgical state.…”

Section: The Pediatric Ambulatory Patientmentioning

confidence: 99%

An analysis of risk factors and adverse events in ambulatory surgery

Kent¹,

Metzner²

2014

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Care for patients undergoing ambulatory procedures is a broad and expanding area of anesthetic and surgical practice. There were over 35 million ambulatory surgical procedures performed in the US in 2006. Ambulatory procedures are diverse in both type and setting, as they span the range from biopsies performed under local anesthesia to intra-abdominal laparoscopic procedures, and are performed in offices, freestanding ambulatory surgery centers, and ambulatory units of hospitals. The information on adverse events from these varied settings comes largely from retrospective reviews of sources, such as quality-assurance databases and closed malpractice claims. Very few if any ambulatory procedures are emergent, and in comparison to the inpatient population, ambulatory surgical patients are generally healthier. They are still however subject to most of the same types of adverse events as patients undergoing inpatient surgery, albeit at a lower frequency. The only adverse events that could be considered to be unique to ambulatory surgery are those that arise out of the circumstance of discharging a postoperative patient to an environment lacking skilled nursing care. There is limited information on these types of discharge-related adverse events, but the data that are available are reviewed in an attempt to assist the practitioner in patient selection and discharge decision making. Among ambulatory surgical patients, particularly those undergoing screening or cosmetic procedures, expectations from all parties involved are high, and a definition of adverse events can be expanded to include any occurrence that interrupts the rapid throughput of patients or interferes with early discharge and optimal patient satisfaction. This review covers all types of adverse events, but focuses on the more severe adverse events that are associated with morbidity requiring unplanned admission to hospital and mortality.

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“…Children are ideal for day surgery as there is minimal separation from parents and risk of hospital-acquired infection. [124] Federation of ambulatory surgery association has observed that there is no significant relationship with pre-existing diseases and incidence of post-operative complications; elderly with multiple co-morbidities are also acceptable for day surgery. [2]…”

Section: Patient Selectionmentioning

confidence: 99%

Rapid emergence of day-care anaesthesia: A review

et al. 2012

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The number of day-care surgeries is increasing every day. The boundaries of day-care surgeries are being redefined on a continual basis. Multi-dimensional benefits to the patient, hospital and national economy are the driving forces behind the changing scenario on the horizon of day surgery. The literature search included Google, medlinx, pubmed and medline. We have attempted to look at the controversies in patient selection with comorbidities, pre-operative assessment and an acceptable ASA grade of patients. An attempt is also made to look at suitable surgical procedures, a pathway of introducing procedures, which are still complex and specialist procedures in challenging environment. The techniques of general anaesthesia, central neuraxial blocks, regional nerve blocks with indwelling catheters and monitoring techniques are deliberated upon. Finally the most important post-operative issues of discharge criteria, including recovery after spinal anaesthetic, oral fluid intake, voiding and travel after day surgery, are considered.

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Challenges in Pediatric Ambulatory Anesthesia: Kids are Different

Cited by 19 publications

References 87 publications

Procedural sedation and analgesia in children undergoing digestive endoscopic procedures – paediatrician or anaesthesiologist?

Procedural sedation and analgesia in children undergoing digestive endoscopic procedures – paediatrician or anaesthesiologist?

An analysis of risk factors and adverse events in ambulatory surgery

Rapid emergence of day-care anaesthesia: A review

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