Paediatric Anaesthesia Department

Guidelines for the Suitability of Children for "Day Stay Procedures"

"Day Stay Procedure" means that the child will be admitted to and discharged from hospital on the same day as the procedure or investigation.

This is a guideline only and ultimately the decision as to the suitability of the child for Day Stay Procedures rests with the anaesthetist caring for the child in consultation with the attending surgeon.

1. Suitable Day Stay Procedures:

Procedures which cause minimal blood loss
Procedures where there is minimal risk of post-procedural airway compromise
Post-procedural pain can be controlled with oral or rectal analgesics
Any care required post procedurally can be met by the carer in the home.
An expected rapid return to normal food and fluid intake.
Day Stay Procedures to be given priority on procedure list sequence.

2. children Suitable for Day Stay Procedures:

Lower acceptable age limit in full term infants for Day Stay Procedures is 46 weeks post conceptual age (PCA).
where: Full term = >37 weeks gestational age

PCA = age in weeks + gestational age.

**Full term infants of 46 weeks PCA may be as old as 2 ½ months post natal age.

**Ex-premature infants and neonates are a special case, as they are at risk of post-procedural apnoea. Ex-premature infants may be at risk even as late as 7 months post natal age and therefore are not suitable for Day Stay Procedures. Please refer to the guidelines for the post anaesthetic management of ex-premature infants and neonates.

Children who have no systemic disease or only slight systemic disease which interferes no more than moderately with normal activities. (ASA 1 or 2).
Children with pre-existing airway compromise or potential airway compromise may be unsuitable for Day Stay Procedures.

3. Social Requirements for Day Stay Procedures:

The carer to be advised that there is a possibility that the child may be admitted overnight.
Transport of child home only to be by private vehicle or taxi. One other responsible person should be present in the vehicle to look after the child on the way home apart from the driver.
Time taken to cover the distance from this hospital to the home or place of residence must be less than one hour. The child must remain within one hour of appropriate medical attention until the morning following discharge.
The carer must be able to carry out pre and post-procedural instructions.
The carer must have ready access to a telephone in the post-procedural dwelling.
The carer should have written advice as to when the child resume normal activities such as school and sport.
In the case of older children/young adults a responsible person must stay with them at least overnight.
The Department of Paediatric Anaesthesia should be consulted if these guidelines cannot be met.

References:

Review:

Sims C, Johnson CM Post-operative Apnoea in infants. Anaesthesia and Intensive Care. 22(1):40-5,1994 Feb.

Original research:

Liu LM, Cote CJ GoudsouzianNG et al. Life Threatening apnea in infants recovering from anesthesia. Anesthesiology. 59(6):506-10, 1983 Dec

Warner LO, Teitelbaum DH Caniano DA et al. Inguinal herniorrhaphy in young infants: perianesthetic complications and associated preanesthetic risk factors. Journal of Clinical Anesthesia. 4(6):445-61, 1992 Nov-Dec

Bell C Dubose R Touloukian R et al. Infant apnea detection after herniorraphy. Journal of Clinical Anesthesia. 7(3):219-23, 1995 May.

Roetman KJ Welborn LG Hannallah RS et al. Evaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants. Paediatric Anaesthesia 7(5):391-7 1997

O’Brien K. Robinson DN Morton NS. Induction and Emergence in infants less than 60 weeks post-conceptual age: comparison of thiopental, halothane, sevoflurane and desflurane. British Journal of Anaesthesia/\. 80 (4): 456-9, 1998 Apr.

Chipps BE Moynihan R Schieble T Stene R st al. Infants undergoing pyloromyotomy are not at risk for post-operative apnea. Pediatric Pulmonology. 27940; 278-81, 1999 Apr.

Galinkin JL Davis PJ et al A randomized multicenter study of remifentanil compared with halothane in neonates and infants undergoing pyloromyotomy. II Perioperative breathing patterns in neonates and infants with pyloric stenosis Anesthesia and Analgesia. 93(6): 1387-92, table of contents, 2001 Dec.

Case Reports:

Tetzlaff JE, Annand DW et al. Post-operative Apnea in a Full-term Infant. Anesthesiology 69:426-428, 1988.

Cote CJ, Kelly DH. Post-operative Apnea in a Full-Term Infant with a demonstrable respiratory Pattern Abnormality. Anesthesiology 72: 559-561, 1990.

Karyan J, LaCoste L, Fusciardi J. Post-operative Apnea in a Full-Term Infant (letter) Anesthesiology 73: 375, 1991.

Andropoulos DB, Heard MB, Johnson KL. Postanesthetic Apnea in Full-Term Infants after Pyloromyotomy. Anesthesiology, 80 (1) : 216 Jan 1994

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