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The care of the child having ambulatory surgery presents a specific set of challenges to the anesthesia provider. This review focuses on areas of clinical distinction that support the additional attention children often require, and on clinical controversies that require providers to have up-to-date information to guide practice and address parental concerns. These include perioperative risk; obstructive sleep apnea; obesity; postoperative nausea and vomiting; neurocognitive outcomes; and specific concerns regarding common ear, nose, and throat procedures.

PURPOSE OF REVIEW New developments in analgesic drugs and techniques are being applied to the pediatric population. Appropriate pain management for ambulatory surgery patients helps to facilitate early discharge and minimize postoperative morbidity. RECENT FINDINGS A variety of opioid-related drugs, as well as novel delivery routes for opioids, have been reported in the pediatric population. New pharmacokinetic information for acetaminophen has resulted in revised dosage recommendations; applications of the nonsteroidal antiinflammatory agents are also discussed. Furthermore, regional anesthesia and adjuncts are useful in the pediatric ambulatory surgery patient. SUMMARY Recent data on techniques for pain management after pediatric ambulatory surgery will help the anesthetist develop a comprehensive plan for the postoperative period.

Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed.

Pediatric patients present for a wide variety of ambulatory surgical procedures. In general, children are good candidates for ambulatory surgery, but the patient screening and selection process needs to ensure that significant associated conditions are avoided, particularly in the freestanding ambulatory setting. General patient selection concepts and overall risk information for the pediatric patient are presented. Specific clinical challenges presented by pediatric patients are summarized in this chapter, including respiratory issues such as respiratory infection and sleep apnea, gastrointestinal reflux, congenital heart disease, Down syndrome, neuromuscular disorders, and children with hematologic disorders and cancer.