Paediatric day-case anaesthesia and pain control.
OBJECTIVE
More surgery on children is being carried out on a day-case basis and we review the anaesthetic management. Selection of appropriate patients and procedures is vital and careful preparation of children and families minimizes fear and anxiety and streamlines the organizational aspects of care. Simple, noninvasive general-anaesthetic techniques with modern agents are recommended. Good analgesia is important and is based upon local or regional blockade, nonsteroidal antiinflammatory drugs and paracetamol, with opioids being reserved for rescue analgesia. Omission of opioids helps to minimize postoperative emesis. Discharge home is facilitated by clear instructions about activities, dressings, wound care and continuing pain control.


RESULTS
Oral clonidine premedication, new, safer local anaesthetic agents, ultrasound guidance for blocks and prolongation of single-injection caudal blocks with clonidine or ketamine are recent developments. Guidelines for safe sedation and analgesia for procedures are available. Behavioural and cognitive changes can be seen in children after anaesthesia and surgery and parents should be informed of this possibility.


CONCLUSIONS
Children benefit particularly from day care and recent advances in anaesthesia and pain management have allowed a huge expansion of this modality of care with a consequent reduction in the need for children to be in hospital.
Lonnqvist
Per-Arne
PA
Department of Anaesthesia, Astrid Lindgrens Children's Hospital, Stockholm, Sweden. Per-Arne.Lonnqvist@ki.se
Morton
Neil S
NS
D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000758:Anesthesia / Q000379:methods; D000762:Anesthesia Recovery Period; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006701:Home Nursing; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010290:Parents / Q000193:education; D018579:Patient Selection; D010372:Pediatrics; D011182:Postoperative Care; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D017410:Practice Guidelines as Topic
D000700:Analgesics; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives