Pediatric Day Surgery in Sweden

1. Pediatric Day Surgery in Sweden M Brattwall§, J Jakobsson#, N Rawal^^, M Segerdahl*, M. Warrén-Stomberg¤ Conclusion: In Sweden, many units perform paediatric surgery, most children receive premedication, anaesthesia is induced i.v. and take-home analgesics are often provided. Postoperative pain is still the most common complaint after discharge. IntroductionDay surgery constitutes a large part, approximately 46%, of all paediatric surgical practice. Safe routines including parental and child information in order to optimize care and reduce anxiety is important. Most day surgery units are not dedicated to paediatric care, why specific paediatric expertise is often lacking. Fig 1. Day surgery is more common than in-house surgery Some units see very few children, while others see very many. Fig 3. Most units provide NSAIDs and paracetamol for children alla ages. Methods: We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining a 88% response rate. NSAIDs were also common pain medication, also as monotherapy. Rescue medication in the recovery was i.v. morphine. At 42% of units, take-home bags of analgesics were provided for 1-3days of treatment, together with oral and often written instructions. Instructions on pain assessments were rare. At follow-up telephone calls, pain was the most frequent complaint. After circumcision, micturition difficulties were common, after adenoidectomy nausea and after tonsillectomy nutrition due to swallowing difficultieswere also common. Results: The proportion of day surgery vs. in-hospital procedures was 46% in children. Seventy-one out of 88 responding units performed paediatric day surgery (Fig 1). All younger children (age 1-6y) received anxiolytic premedication, 67% by oral route, while 60% of units gave premedication to 7-16 year-olds, mainly by oral route. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy on a day surgery basis. Anaesthesia induction was mainly intravenous in older children and at Fig 2. Most units use IV induction at all ages. 50% of units in 1-6 year olds (Fig. 2). Parents were present during induction. Postoperatively, 93% of units routinely assessed patients’ pain. Paracetamol was the most common analgesic, and was often combined (Fig 3). • In pediatric care, day surgery is more common than in-house surgery. • Most units have uniform routines across the country • Even though pain relief is a major concern for Day Surgery • staff, it is still a major problem on follow-ups. ¤University of Skövde; School of Life Sciences, Skövde; *Dept of Clinical Science, Intervention and Technology, Unit for Anesthesia, Karolinska Institute, Stockholm; ^^Department of Anesthesia and Intensive Care, Örebro University Hospital, Örebro; §Sahlgrenska University Hospital/Mölndal, Unit of Day Care Surgery, Göteborg; #Karolinska Institutet, Department of Physiology and Pharmacology, unit for Anesthesia, Stockholm, SWEDEN