nach oben

04.03.2024 | Ambulatory Anesthesia (G Joshi, Section Editor)

Pediatric Ambulatory Surgery: What’s New, What’s Controversial

verfasst von: Audra M. Webber, Marjorie P. Brennan, James Bradley

Erschienen in: Current Anesthesiology Reports

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

This article aims to review recent innovations and trends in ambulatory anesthesia through the lens of the pediatric ambulatory population and strategizes the feasibility of implementation for individual ambulatory sites.

Recent Findings

Reducing greenhouse gasses via total intravenous anesthesia (TIVA) and/or low fresh gas flows (FGF), the expansion of 23-h stays, and increasing prescriptions for GLP-1 agonists are all contemporary issues with relevance to pediatric ambulatory surgery.

Summary

Pediatric patients present unique challenges for environmental stewardship. It is likely eliminating nitrous oxide and using low flows for sevoflurane are most effective for ear tubes, while tonsillectomy and other procedures may utilize TIVA alone. In certain instances, providing 23-h stays to pediatric ambulatory patients can positively impact the healthcare system as a whole. Finally, GLP-1 agonists have been approved for pediatric patients and practitioners should know the implications for this patient population. Dependent upon individual ASCs, these changes can represent new opportunities to better serve the community.

Fortune Business Insights. U.S. ambulatory surgical centers market size, share & COVID-19 impact analysis, by type of center (single specialty and multi-specialty), by ownership (physician-owned, hospital-owned and corporate-owned) by application (diagnostic services and surgical services), and forecase 2021–2028. Market research report 2022:1–77.

MacNeill AJ, Lillywhite R, Brown CJ. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health. 2017;1(9):e381–8. https://doi.org/10.1016/S2542-5196(17)30162-6.

Practice Greenhealth: Greening the OR and Climate. 2019. https://practicegreenhealth.org/sites/default/files/2019-04/anesthetic_gas_how-to.pdf. Accessed 10 Dec 2023.

•• Hansen EE, Chiem JL, Righter-Foss K, Zha Y, Cockrell HC, Greenberg SLM, et al. Project SPRUCE: saving our planet by reducing carbon emissions, a pediatric anesthesia sustainability quality improvement initiative. Anesth Analg. 2023;137:98–107. https://doi.org/10.1213/ANE.0000000000006421. One of the first reviews of environmental sustainability specifically for pediatric anesthesia.CrossRefPubMed

21.World Health Organization. 2023. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health. Accessed 14 Dec 2023.

Blacoe DA, Cunning E, Bell G. Paediatric day-case surgery: an audit of unplanned hospital admission Royal Hospital for Sick Children. Glasgow Anaesth. 2008;63:610–5. https://doi.org/10.1111/j.1365-2044.2008.05438.x.CrossRef

Patel RI, Hannallah RS. Anesthetic complications following pediatric ambulatory surgery: a 3-yr study. Anesthesiology. 1988;69:1009–12. https://doi.org/10.1097/00000542-198812000-00044.CrossRefPubMed

Ortiz AC, Atallah AN, Matos D, da Silva EM. Intravenous versus inhalational anaesthesia for paediatric outpatient surgery. Cochrane Database Syst Rev. 2014;2014(2):CD009015. https://doi.org/10.1002/14651858.CD009015.

•• Karam C, Zeeni C, Yazbeck-Karam V, Shebbo FM, Khalili A, Abi Raad SG, et al. Respiratory adverse events after LMA® mask removal in children: a randomized trial comparing propofol to sevoflurane. Anesth Analg. 2023;136:25–33. https://doi.org/10.1213/ANE.0000000000005945. Recent article comparing respiratory adverse events with TIVA compared to volatile anesthetic in pediatric patients.CrossRefPubMed

10.

Pieters BJ, Penn E, Nicklaus P, Bruegger D, Mehta B, Weatherly R. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. Paediatr Anaesth. 2010;20:944–50. https://doi.org/10.1111/j.1460-9592.2010.03394.x.CrossRefPubMed

11.

Oofuvong M, Geater AF, Chongsuvivatwong V, Chanchayanon T, Sriyanaluk B, Saefung B, et al. Excess costs and length of hospital stay attributable to perioperative respiratory events in children. Anesth Analg. 2015;120:411–9. https://doi.org/10.1213/ANE.0000000000000557.CrossRefPubMed

12.

Davidson AJ, Shrivastava PP, Jamsen K, Huang GH, Czarnecki C, Gibson MA, et al. Risk factors for anxiety at induction of anesthesia in children: a prospective cohort study. Paediatr Anaesth. 2006;16:919–27. https://doi.org/10.1111/j.1460-9592.2006.01904.x.CrossRefPubMed

13.

Varughese AM, Nick TG, Gunter J, Wang Y, Kurth CD. Factors predictive of poor behavioral compliance during inhaled induction in children. Anesth Analg. 2008;107:413–21. https://doi.org/10.1213/ane.0b013e31817e616b.CrossRefPubMed

14.

Aguilera IM, Patel D, Meakin GH, Masterson J. Perioperative anxiety and postoperative behavioural disturbances in children undergoing intravenous or inhalation induction of anaesthesia. Paediatr Anaesth. 2003;13:501–7. https://doi.org/10.1046/j.1460-9592.2003.01002.x.CrossRefPubMed

15.

Lee JJ, Price JC, Duren A, Shertzer A, Hannum R, Akita FA, et al. Ultrasound evaluation of gastric emptying time in healthy term neonates after formula feeding. Anesthesiology. 2021;134:845–51. https://doi.org/10.1097/ALN.0000000000003773.CrossRefPubMed

16.

Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC, et al. Clinical practice guideline: tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022;166:S1-55. https://doi.org/10.1177/01945998211065662.CrossRefPubMed

17.

American Hospital Association, American Society of Anesthesiologists. Optimizing perioperative performance in today’s resource-constrained environment tackling the surgical backlog. Executive dialogue 2023:1–10. https://www.aha.org/system/files/media/file/2023/02/ASA_SurgicalBacklog_exedialogue_Feb2023.pdf. Accessed 22 Jan 2024

18.

•• Ardon AE, Nimma S, Nin OC. Twenty-three-hour stays in the ambulatory surgical center: benefits, pathways and protocols. Curr Opin Anaesthesiol. 2023;36:617–23. https://doi.org/10.1097/ACO.0000000000001306. Review about feasibility and strategy for implementing 23-h stays in ambulatory centersCrossRefPubMed

19.

Pang G, Kwong M, Schlachta CM, Alkhamesi NA, Hawel JD, Elnahas AI. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery. J Surg Res. 2021;263:71–7. https://doi.org/10.1016/j.jss.2021.01.024.

20.

Sibia US, Klune JR, Turcotte JJ, Holton LH III, Riker AI. Hospital-based same-day compared to overnight-stay mastectomy: an American College of Surgeons National Surgical Quality Improvement Program analysis. Anne Arundel Med Center Luminis Health. 2022;22:481–1000. https://doi.org/10.31486/toj.21.0103.CrossRef

21.

Raimbert P, Voron T, Laroche S, O'Connell L, Debove C, Challine A, Parc Y, Lefèvre JH. Ambulatory appendectomy for acute appendicitis: can we treat all the patients? A prospective study of 451 consecutive ambulatory appendectomies out of nearly 2,000 procedures. Surgery. 2023;173(5):1129–36. https://doi.org/10.1016/j.surg.2023.01.003.

22.

Parsons C, Odom S, Cooper R, Fischkoff K, Putnam B, Kim D, et al. Analysis of outcomes associated with outpatient management of nonoperatively treated patients with appendicitis. JAMA Netw Open. 2022;5:e2220039. https://doi.org/10.1001/jamanetworkopen.2022.20039.CrossRef

23.

Cairo SB, Raval MV, Browne M, Meyers H, Rothstein DH, Affiliations A, et al. Association of same-day discharge with hospital readmission after appendectomy in pediatric patients CME quiz at jamanetwork.com/learning. JAMA Surg. 2017;152:1106–12. https://doi.org/10.1001/jamasurg.2017.2221.CrossRefPubMedPubMedCentral

24.

Rajasingh CM, Baker LC, Wren SM. Freestanding ambulatory surgery centers and patients undergoing outpatient knee arthroplasty + supplemental content. JAMA Netw Open. 2023;6:2328343. https://doi.org/10.1001/jamanetworkopen.2023.28343.CrossRef

25.

• Tian Y, Allen LD, Ingram ME, Raval MV. Disparities in delivery of ambulatory surgical care for children. JAMA Netw Open. 2023;6(6):e2317018. https://doi.org/10.1001/jamanetworkopen.2023.17018. Article highlighting healthcare disparities in ambulatory pediatric anesthesia.

26.

de Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92:1257–64. https://doi.org/10.3945/ajcn.2010.29786.CrossRefPubMed

27.

Bryan S, Afful J, Carroll M, Te-Ching C, Orlando D, Fink S, Fryar CD. NHSR 158. National health and nutrition examination survey 2017–March 2020 Pre-pandemic data files. (2021).

28.

Han C, Song Q, Ren Y, Chen X, Jiang X, Hu D. Global prevalence of prediabetes in children and adolescents: a systematic review and meta-analysis. J Diabetes. 2022;14:434–41. https://doi.org/10.1111/1753-0407.13291.CrossRefPubMedPubMedCentral

29.

Gribble FM, Reimann F. Metabolic Messengers: glucagon-like peptide 1. Nat Metab. 2021;3:142–8. https://doi.org/10.1038/s42255-020-00327-x.CrossRefPubMed

30.

Halawi H, Khemani D, Eckert D, O’Neill J, Kadouh H, Grothe K, et al. Effects of liraglutide on weight, satiation, and gastric functions in obesity: a randomised, placebo-controlled pilot trial. Lancet Gastroenterol Hepatol. 2017;2:890–9. https://doi.org/10.1016/S2468-1253(17)30285-6.CrossRefPubMed

31.

Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–44. https://doi.org/10.1056/NEJMoa1607141.CrossRefPubMed

32.

Watanabe JH, Kwon J, Nan B, Reikes A. Trends in glucagon-like peptide 1 receptor agonist use, 2014 to 2022. J Am Pharm Assoc 2024;64(1):133–8. https://doi.org/10.1016/j.japh.2023.10.002.

33.

• Joshi GP. Anesthetic considerations in adult patients on glucagon-like peptide-1 receptor agonists: gastrointestinal focus. Anesth Analg. 2024;138:216–20. https://doi.org/10.1213/ANE.0000000000006810. Recommendations for management of patients on GLP-1 agonists from ambulatory expertsCrossRefPubMed

34.

•• Joshi G, Abdelmalak B, Weigel W, Sulpicio S, Harbell MW, Kuo CI, et al. American society of anesthesiologists consensus-based guidance on preoperative management of patients (adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. ASA Press Release 2023. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative. Accessed 22 Jan 2024. ASA recommendations for pediatric (and adult) patients taking GLP-1 agonists.

35.

Gulak MA, Murphy P. Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report. Can J Anesth/J Can d’anesthésie. 2023;70:1397–400. https://doi.org/10.1007/s12630-023-02521-3.CrossRef

36.

Yan Y, Gong Y, Jiang M, Gao Y, Guo S, Huo J, Zhao Z, Li C. Utilization of glucagon-like peptide-1 receptor agonists in children and adolescents in China: a real-world study. Front Endocrinol (Lausanne). 2023;14:1170127. https://doi.org/10.3389/fendo.2023.1170127.

37.

Moake MM, Presley BC, Hill JG, Wolf BJ, Kane ID, Busch CE, et al. Point-of-care ultrasound to assess gastric content in pediatric emergency department procedural sedation patients. Pediatr Emerg Care. 2022;38:e178–86. https://doi.org/10.1097/PEC.0000000000002198.CrossRefPubMedPubMedCentral

38.

Bouvet L, Bellier N, Gagey-Riegel A, Desgranges F, Chassard D, De Queiroz SM. Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: a prospective cohort study. Pediatr Anesth. 2018;28:906–13. https://doi.org/10.1111/pan.13472.CrossRef

39.

Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: a mini-review of key diagnostic features and protocols. World J Crit Care Med. 2022;11:70–84. https://doi.org/10.5492/wjccm.v11.i2.70.CrossRefPubMedPubMedCentral

40.

Arzola C, Carvalho JCA, Cubillos J, Ye XY, Perlas A. Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study. Can J Anaesth. 2013;60:771–9. https://doi.org/10.1007/s12630-013-9974-y.CrossRefPubMed

Titel: Pediatric Ambulatory Surgery: What’s New, What’s Controversial
verfasst von: Audra M. Webber
Marjorie P. Brennan
James Bradley
Publikationsdatum: 04.03.2024
Verlag: Springer US
Erschienen in: Current Anesthesiology Reports
Elektronische ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-024-00624-1

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Pediatric Ambulatory Surgery: What’s New, What’s Controversial

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet AINS

Sind Frauen die fähigeren Ärzte?

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Update AINS

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet AINS

Sind Frauen die fähigeren Ärzte?

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Update AINS