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PEDIATRICS
Photo by Piron Guillaume on Unsplash

Ambulatory

Surgery

for the Pediatric Patient

By Michael Kim, MD

the early 1980’s an estimated 10 percent of surgeries and pharmaceuticals surgery has never been safer than it is today.
In took place in an ambulatory setting. With the increase However, if you do enough cases and anesthetize enough patients,

in number of ambulatory surgical centers, the advent
the less than 1 percent complication or crisis will arise and it is in
of less invasive and less morbid surgical techniques, these moments all those years of training come into play.
and lower costs, more recent data suggest that over 70 percent of sur- Not long ago I had a healthy pediatric patient under my care for
geries performed in the United States are performed in an ambulatory an elective dental procedure. Despite a thorough history and phys-
setting (1). It is thus, not surprising that a similar rate of utilization ical, it turns out the patient contracted an upper respiratory infection
of ambulatory surgical centers exists in the pediatric population. A that had not yet manifested any significant symptoms. In the recov-
recent study suggested that there has been a 50 percent increase in ery room after completion of the surgery, this child suddenly de-
pediatric visits from 1996-2006 from 1.6 million to 2.3 million/year veloped severe/life threatening airway edema. Fortunately, early
(2). As a result, more and more parents are faced with the reality that recognition and treatment led to early intervention that saved the
their child will have an operation outside of a hospital setting. My child’s life and prevented any long-term sequelae, but the fact that
hope is to shed some light on the pros and cons, address the issue of despite all the appropriate screening, physical exam, history and
safety and discuss how to prepare your child for surgery. physical a situation like this can arise, speaks to the seriousness of
placing any child under general anesthesia. Fortunately, this situation
Is it safe? is the exception and not the rule. A recent Canadian study showed
We have all seen the news headlines of a healthy child undergoing that the incidence of unanticipated hospital admissions follow am-
an elective procedure suffering catastrophic complications. This sit- bulatory surgery at a pediatric hospital was slightly less than 1 per-
uation is what all anesthesiologists spend 4 years of medical school, cent (3). The incident of unanticipated hospital admission is likely
4 years of specialized anesthesia training and countless hours inside less due to stricter patient selection criteria in the ambulatory surgi-
and outside the operating room studying and preparing for. The cal setting. Risk factors for hospital admission included Age < 1year,
vast majority of surgeries and anesthetic exposures proceed without prematurity, Surgery Duration >1hr, Type of surgery (orthopedic,
incident and with innovations in monitoring, anesthesia equipment, dental, ear nose throat), intraoperative event, obstructive sleep apnea

14 San Antonio Medicine • June 2018