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Challenges in paediatric ambulatory anesthesia

Hanna, Amgad H.; Mason, Linda J.

Current Opinion in Anaesthesiology: June 2012 - Volume 25 - Issue 3 - p 315–320
doi: 10.1097/ACO.0b013e3283530de1

Purpose of review 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.

Recent findings 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.

Summary 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 acetaminophen is presented as an opioid-sparing analgesic. Dexamethasone is effective in preventing postoperative nausea without increased risk of bleeding. Surgical techniques may affect postoperative pain.

Department of Anesthesiology, Loma Linda University, Loma Linda, California, USA

Correspondence to Linda Mason, MD, Department of Anesthesiology, Loma Linda University, Loma Linda, CA 92354, USA. Tel: +1 909 5588261; fax: +1 909 5580216; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.