Ambulatory anesthesia for children undergoing laser treatment

Since 1993, we have performed laser surgery for cutaneous lesions, such as simple hemangioma and nevus of Ota, in children under ambulatory anesthesia. Although we anticipate that the numbers of patients treated under ambulatory anesthesia will increase, few reports detail the procedures involved and their perioperative management. We describe this method of anesthesia and discuss its limitations, and future issues.

To date, we have performed laser treatment on 633 pediatric patients under ambulatory anesthesia. The mean age of the children was 3.6 +/- 1.9 years and their mean weight was 16.4 +/- 4.7 kg. The lesions treated included simple hemangioma, nevus of Ota, nevus pigmentosus, nevus spilus, and ectopic Mongolian spots. Anesthesia is induced with oxygen, nitrous oxide, and sevoflurane; then an intravenous cannula is inserted under spontaneous respiration. Anesthesia is maintained with assisted ventilation using a mask. Children are not intubated unless a mask cannot be used because the lesion is on the face or back.

No serious peri- or postoperative complications were encountered and there were no serious adverse reactions to anesthesia. With the exception of one child who was admitted overnight for a low-grade fever, all were released from hospital within a few hours.

Ambulatory anesthesia can be performed safely using oxygen, nitrous oxide, and sevoflurane for the laser treatment of cutaneous lesions in pediatric patients.