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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2003 March;69(3):137-44

language: English, Italian

One-stop surgery in pediatric surgery. Aspects of anesthesia. Preliminary report

Astuto M. 1, Disma N. 1, Sentina P. 1, Sanges G. 2

1 Department of Anesthesia, Azienda Policlinico, University of Catania, Catania, Italy
2 Department of Pediatric Surgery, Azienda Policlinico, University of Catania, Catania, Italy


Aim. One-Stop Surgery (OSS) is a new day sur­gery com­bin­ing pre­op­er­a­tive eval­u­a­tion and sub­se­quent oper­a­tion in one med­i­cal exam­ina­tion.
Methods. This ­paper ­reports the ­authors’ ­initial expe­ri­ence ­using ­this meth­od. Referring phy­si­cians ­were ­informed of the meth­ods and select­ed sur­gi­cal and anes­thet­ic pro­ce­dures by fax. They ­were ­also ­faxed a ­form to ­fill in ­with ­case his­to­ry ­details and instruc­tions to the par­ents on the pre­op­er­a­tive ­fast. The com­plet­ed ­form was ­faxed ­back to the sur­geon and pedi­at­ric anes­the­tist who deter­mined ­patient suit­abil­ity and sched­uled hos­pi­tal­iza­tion and sur­gery. On hos­pi­tal­iza­tion phys­i­cal exam­ina­tion was per­formed to con­firm diag­no­sis and ­rule out con­tra­in­di­ca­tions for anes­the­sia. Patients con­sid­ered suit­able ­then under­went sur­gery and ­were dis­charged on the ­same day as a day ­case. The fam­i­lies ­were giv­en instruc­tions to be fol­lowed for ­home ­care and emer­gen­cy tele­phone num­bers. In the ­time inter­val November 2000 to February 2001 43 ­patients ­aged ­between 2 and 7 ­years ­were treat­ed fol­low­ing ­this pro­ce­dure for remov­al of a cen­tral ­venous cath­e­ter (16 ­patients), umbil­i­cal (2 ­patients) and ingui­nal (10 ­patients) her­nia ­repair, and pre­puce dor­sal ­slit (15 ­patients). Anesthesia con­sist­ed of ­nasal pre­med­i­ca­tion ­using mid­az­o­lan, gen­er­al inha­la­tion anes­the­sia and periph­er­al loco­re­gion­al ­block.
Results. The diag­no­sis of all chi­dren was con­firmed. Only 1 ­patient ­with ­upper air­way infec­tion was dis­cov­ered. Recovery of all ­patients was unevent­ful. None of the ­patients ­called dur­ing the post­op­er­a­tive fol­low-up peri­od for ­adverse ­events.
Conclusion. Low ­costs and ­major par­ent and ­patient sat­is­fac­tion are the ­main advan­tag­es of OSS, ­while the pos­sible dis­ad­van­tag­es are inac­cu­rate refer­ral for sur­gery and detec­tion of con­tra­in­di­ca­tions for anes­the­sia at admit­tance to hos­pi­tal. The ­authors rec­om­mend the use of ­wide ­scale OSS ­only ­when the oper­a­tors ­have ­sound expe­ri­ence in pedi­at­ric day sur­gery.

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