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Anesthetic considerations for pediatrics-outpatient
(day care surgeries)
PREPARED BY
YEWLSEW FENTIE
ADVISOR: Mr.LEULAYEHU AKALU
April 2014
Contents
• Objective
• Introduction
• Why day case surgery?
Advantages of day case surgery
Facilities
• Advances in pediatrics day case surgery
• Candidates for pediatrics ambulatory surgery
• Pre-operative assessment
• Intra-operative management
• Postoperative management
Post operative pain management
Recovery and discharge criteria
• summary
• Reference
General objective
Intra-operative mgt cont…
multimodal approach using local anesthesia, paracetamol
and NSAIDs if NSAIDs alone fail to control.
Opioids
not ideal for pediatric day case surgery b/c
• produce ventilatory depression
• excessive sedation and PONV.
Procedures such as adenotonsillectomy may require
opioid therapy so we can use fentanyll (1-2mcg/kg)
commonly .
Intra-operative mgt cont..
Regional blocks (Peripheral nerve blocks)
Recovery
After day case surgery ,children should recover in a fully equipped
recovery room .
POSTOPERATIVE NAUSEA AND VOMITING
•The successful management of PONV is an important component
in the care of children after surgery. PONV may cause discomfort
and distress, delay recovery and prolong hospitalization. A
multimodal management approach is useful:
•Avoid emetogenic anesthesia techniques (e.g. morphine IV)
•Preoperative intravenous hydration
•Adequate pain control
•Multiple different antiemetic medications (double or triple
combination antiemetic therapy acting at different neuroreceptor
sites) eg.Droperidol at low dose 20micrgrm per kg.
Post- operative mgt cont…
Some of the commonly used antiemetics include:
• Ondansetron 0.1mg/kg IV
• Dexamethasone 0.1mg/kg IV
• Cyclizine 0.5-1 mg/kg IV
Postoperative pain control
postoperative pain should be controlled by
• NSAIDS
• Short acting Opioids
• Multimodal approach
Post operative mgt…
Discharge criteria
Deciding appropriate time to discharge the child home
depends on
• anesthetic, surgical, and social factors
• adequacy of post operative symptom control.
Post operative mgt
A more objective discharge scoring system has been developed to
evaluate and document the patient's readiness for discharge. The
so-called post anesthetic discharge scoring (PADS) system ; it is
based on five major criteria:
• (1) Vital signs, including blood pressure, heart rate, respiratory rate,
and temperature
• (2) Ambulation and mental status
• (3) Pain and PONV
• (4) Surgical bleeding
• (5) Fluid intake/output.
Patients who achieve a score of 9 or greater are considered fit for
discharge (or “home ready”).
Modified Post anesthesia Discharge Scoring (PADS) System
Vital Signs Pain
2 Minimal
1 Moderate
0 Severe
Post-operative mgt cont…
Generally the following criteria must be met before discharge:
• Vital signs and conscious levels should be normal
• Protective airway reflexes fully regained
• No respiratory distress or strider
• No unexpected intraoperative anesthetic events
• No bleeding/surgical complication
• PONV absent/mild
• Pain absent/mild
• appropriate ambulation
• Written or verbal instructions issued
• Escort home by responsible adult
Post operative mgt cont…
FOLLOW UP
follow up of discharged patent is mandatory for the success
and effectiveness of day case surgery. it may be by :
phone
Or by other communication means
summary
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References