Anaesthesia for Ambulatory Paediatric Surgery: Common techniques and complications

Abstract

BACKGROUND: Ambulatory surgical care accounts for over 70% of elective procedures in Northern America. Ambulatory paediatric surgical practice is not widespread in Nigeria. This report examined clinical indicators for quality care in paediatric ambulatory surgery using common outcomes after day case procedures as benchmark.
METHODS: This was a cross-sectional study of children who were presented for ambulatory surgical care in the University of Benin Teaching Hospital. A standardized questionnaire was employed to record the age, gender, indication for surgery, type of anaesthesia, timelines for the surgery and associated complications. RESULTS: A total of 93 patients had surgical procedures on ambulatory basis. The mean age of the patients was 4.1 ? 4.0yr and duration of surgical procedure 31.3 ± 12.1 min. The male/female ratio was 3:1, and herniotomy was the most frequent procedure on ambulatory paediatric surgical care 60 (64.5%). The common anaesthetic techniques employed in the paediatric ambulatory setting were spontaneous respiration with face mask 40 (43%), Inhalation technique with tracheal intubations 31 (33.3%), general anaesthesia with relaxant technique five (5.4%), local infiltration with or without sedation eight (8.6%), GA plus caudal block eight(8.6%), and subarachnoid block
one(1.1%). The indicators of quality care were unanticipated admission (5.4%), repeat hospital visit (4.3%), readmission (2.2%) and delayed discharge (21.5%). CONCLUSION: The practices of paediatric surgery on ambulatory services are feasible in our setting. The observable  complications are within acceptable limits. The timelines in the scheduling and discharge appear not to be optimal for an effective ambulatory service. 

WAJM 2009; 28(5): 304–307.

Keywords: Ambulatory care, Paediatric surgery, Anaesthesia, Outcome.