The purpose of this study was to assess the current selection criteria for outpatient surgery in children among Canadian pediatric anesthesiologists.
A survey specifying 20 different medical situations was sent to 120 members of the Canadian Pediatric Anesthesia Society. Members were asked to indicate if they agreed or refused to provide anesthesia for children with one or more clinical condition or symptoms. Consensus was defined as a >70% majority opinion.
Sixty-four pediatric anesthesiologists replied (53.3%). For 13 conditions there was no consensus among members. Seven scenarios resulted in a consensus of either providing or not providing anesthesia in an outpatient setting. The majority of members would agree to provide anesthesia for the following scenarios: (i) an asymptomatic child with recurrent otitis media, rectal temperature of 38 degrees C; (ii) the same child with chronic nasal discharge for bilateral myringotomy and tube placement; (iii) an asymptomatic child with sickle-cell disease (SCD) for cast change; (iv) an asymptomatic child with asthma and fever for bilateral myringotomy and tube placement (BMT); (v) a morbidly obese child with congested nose for BMT; and (vi) a child with well controlled insulin dependent diabetes mellitus for magnetic resonance imaging (MRI). Most members would refuse to provide outpatient anesthesia in an asymptomatic child with SCD for tonsillectomy.
Further studies are needed to establish evidence-based medicine to support guidelines that would allow one to select children safely for ambulatory surgery.
A retrospective study of 2,338 outpatient surgical procedures performed at the Centre Hospitalier de l'Université Laval was undertaken. There were 1,308 men and 1,030 women, with a mean age of 40.7 years. General anaesthesia was used in 91.5 per cent of the cases. After surgery, the patients were discharged according to the criteria described by Wetchler and Kortilla. The unanticipated hospital admission rate was 6.1 per cent and the complication rate was 1.3 per cent with no life threatening conditions. Proper selection and preparation of the patient, severe criteria for safe discharge after Day Surgery are mandatory for the patient's safety and satisfaction.
Most surgeons and hospital administrators now recognize that many surgical procedures can be done on an out-patient basis and anesthetists have been instrumental in developing and implementing the practice of short-stay surgery. It is our opinion that general anaesthesia using enflurane and Alfathesin will increase the safety of ambulatory surgery.