Children in day surgery: clinical practice and routines. The results from a nation-wide survey.
BACKGROUND
Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking.


METHODS
We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail.


RESULTS
The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1-6-year-olds, and in 7-16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1-6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1-3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy.


CONCLUSIONS
In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.
Segerdahl
M
M
Department of Clinical Science, Intervention and Technology, Karolinska Institute, CLINTEC Unit for Anesthesia, Karolinska Universitetssjukhuset Huddinge, Stockholm, Sweden. marta.segerdahl@ki.se
Warrén-Stomberg
M
M
Rawal
N
N
Brattwall
M
M
Jakobsson
J
J
D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008738:Methyl Ethers; D010147:Pain Measurement / Q000187:drug effects* / Q000706:statistics & numerical data; D010290:Parents; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D015742:Propofol; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D000077149:Sevoflurane; D013548:Sweden
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol