Pediatric Ambulatory Anesthesia

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.