Paediatric day case anaesthesia

Abstract

Summary In the past 30 years there have been significant advances in anaesthetic and surgical techniques, equipment and pharmacology. These, together with the better understanding of the psychological effects of hospitalization on children, and encouraged by escalating health care costs, have stimulated a worldwide expansion in paediatric day stay surgery. Good preoperative preparation of both parents and child is vitally important to ensure that the surgery involves minimal emotional disturbance. Increasingly, attention is being given to parental involvement in anaesthetic induction and the use of oral or rectal medication where possible. This approach is best achieved in a self-contained day surgery facility with a team of dedicated and caring personnel. Anaesthesia for day surgery must include all the technical facilities and skill that would normally be applied to inpatients. In addition, the anaesthetist must be involved in establishing protocols for selection, preparation and discharge of patients. Important aspects of the perioperative anaesthetic care include efforts to minimize fasting and provision of adequate postoperative pain relief with minimal nausea and vomiting, with regional anaesthesia playing a major role. Follow-up of patients after discharge is also an important means of assessing and improving the quality of day surgical care.