Challenges in paediatric ambulatory anesthesia

Current Opinion in Anaesthesiology
Amgad H Hanna, Linda J Mason

Abstract

Clinical studies and new guidelines are frequently being published in the area of preoperative fasting. A growing population of patients with obstructive sleep apnea is being referred for outpatient procedures including adenotonsillectomy. Recently published preoperative fasting guidelines for pediatric patients are covered along with studies comparing gastric volume following different fasting intervals. Pediatric obstructive sleep apnea is discussed. Clinical presentation, severity, perioperative risks, and controversies as whether outpatient procedures are suitable for these patients are presented. New data covering different perioperative aspects are presented. A more liberal preoperative intake is encouraged with fasting for 2 h for clear liquids, 4  h for breast milk, 6  h for formula and light meals, and 8  h for heavy meals is widely accepted. Interpersonal variation in residual gastric volume exists. Children with obstructive sleep apnea under 3 years of age and those with severe obstructive sleep apnea and comorbidities are not candidates for ambulatory surgery. Polysomnography has specific preoperative indications. Dexmedetomidine can decrease emergence agitation and has an opioid-sparing effect. Intravenous acetamin...Continue Reading

References

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Citations

Oct 16, 2013·Current Opinion in Anaesthesiology·Francis Veyckemans, Mona Momeni
Sep 12, 2015·Current Opinion in Anaesthesiology·Jochen HinkelbeinHarald Genzwürker
Jun 6, 2021·Irish Journal of Medical Science·Vesna MarjanovicChristian Breschan

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