Over the past five decades, there has been a marked increase in the number
of pediatric procedures performed at ambulatory surgical centers (ASCs). This is the
result of multiple factors such as new anesthetic and analgesic agents, new surgical
techniques, and advances in technology. As our health care economics continue to
evolve, it is almost certain that the perioperative landscape will shift even further
towards ambulatory care. The advantages of outpatient surgery include reduced
separation from parents, decreased risk of hospital-acquired infections, less dietary and
nutritional disruption, improved parental satisfaction, and reduced cost. However, the
care of children having ambulatory surgery presents a specific set of challenges. A
hallmark of ambulatory surgery is the overall efficiency of the process from the time of
anesthetic induction until discharge from the hospital. Many factors can delay
discharge procedures, such as preoperative anxiolytics, which can linger for hours, not
amenable to regional anesthetics requiring narcotics, postoperative emergence delirium
(ED), and postoperative nausea and vomiting (PONV). The purpose of this chapter is to
describe preoperative patient evaluation, patient selection criteria, suitable anesthetic
techniques, modes of postoperative analgesia highlighting non-opioid techniques, and
the various challenges that outpatient surgery presents to pediatric anesthesia providers.
Issues relating to postoperative ED and PONV that frequently delay discharge will also
be discussed.
Keywords: Ambulatory anesthesia, Apnea, Deep extubation, Emergence delirium, Health care economics, Non-opioid surgery, Obstructive sleep apnea, Opioid-free surgery, Outpatient surgery, PACU nursing economics, Postoperative nausea and vomiting, Premature, Regional anesthesia, Same-day surgery.
