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

One-Stop Surgery (OSS) is a new day surgery combining preoperative evaluation and subsequent operation in one medical examination.

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.

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.

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.