Fast-tracking children after ambulatory surgery.
This study was designed to determine the feasibility and benefits of fast-tracking children after ambulatory surgery. One-hundred-fifty-five healthy children undergoing surgical procedures lasting <90 min were studied in a randomized manner. After surgery, children who met predefined recovery criteria in the operating room were entered into one of the study groups. Seventy-one patients (control) were first admitted to the postanesthesia care unit (PACU) and then to the second-stage recovery unit (SSRU). Eighty-four children bypassed the PACU and were directly admitted to the SSRU (Fast-Track group). The demographic data, airway management, and surgical procedures were similar in both groups of patients. During the recovery phase, 62.0% of the PACU group patients and 40.5% of the Fast-Track patients received analgesics (P = 0.01). The total recovery time was 79.1 +/- 48.3 min in the Fast-Track group and 99.4 +/- 48.6 min in the Control group (P = 0.008). A larger percentage of parents in the Fast-Track group (31% vs 16%) reported that their child was restless on arrival at the SSRU (P = 0.037). There were no clinically significant adverse events. However, adequate pain control must be provided before transfer to SSRU. In conclusion, fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used.


CONCLUSIONS
The results of this study show that the total recovery time is shorter in children who are fast-tracked (bypass the postanesthesia care unit) after ambulatory surgery. A higher percentage of parents of the Fast-Track group felt that their child was restless on arrival at the second-stage recovery unit. Fast-tracking children after ambulatory surgery is feasible and beneficial when specific selection criteria are used.
Department of Anesthesiology and Pediatrics, Children's National Medical Center and George Washington University Medical Center, Washington, DC 20010, USA. rpatel@cnmc.org
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Patel
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Verghese
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Hannallah
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Aregawi
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Patel
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D000762:Anesthesia Recovery Period; D002648:Child; D002675:Child, Preschool; D003258:Consumer Behavior; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D016343:Monitoring, Intraoperative; D010351:Patient Discharge