Webber Audra M, Brennan Marjorie
Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Department of Anesthesiology, Pain and Perioperative Medicine, The George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia, USA.
Curr Opin Anaesthesiol. 2023 Dec 1;36(6):630-635. doi: 10.1097/ACO.0000000000001321. Epub 2023 Oct 10.
The aim of this article is to briefly review the pediatric ambulatory surgery landscape, identify two of the most common comorbidities affecting this population, examine the influence of pediatric obesity and sleep disordered breathing (SDB)/obstructive sleep apnea (OSA) on perioperative care, and provide information that can be used when formulating site specific criteria for ambulatory surgical centers.
Most pediatric surgeries performed are now ambulatory, a majority of which take place outside of academic centers. Children with comorbidities such as obesity and SDB/OSA are undergoing surgical or diagnostic procedures which were previously deemed unacceptable for ambulatory surgery. The increase in pediatric ambulatory surgery coupled with a recent shortage of pediatric anesthesiologists means many children will receive anesthesia care from general clinicians who care for children intermittently and may be unfamiliar with the perioperative risks these comorbidities can present.
Our pediatric ambulatory surgical population is anticipated to demonstrate increasing rates of obesity and SDB/OSA. Bringing attention to potential perioperative complications associated with these comorbidities provides a stronger foundation upon which to formulate criteria for individual ambulatory centers. It allows for targeted anesthetic management, influences provider assignments and/or staffing ratios, and informs scheduling times. For anesthesiologists who do not practice pediatric anesthesia daily, knowing what to anticipate plays a significant role in the ability to eliminate surprises and care for these patients safely.
本文旨在简要回顾儿科门诊手术的情况，识别影响该人群的两种最常见合并症，研究儿科肥胖症和睡眠呼吸障碍（SDB）/阻塞性睡眠呼吸暂停（OSA）对围手术期护理的影响，并提供在制定门诊手术中心特定场所标准时可使用的信息。
目前大多数儿科手术都是门诊手术，其中大部分在学术中心以外进行。患有肥胖症和SDB/OSA等合并症的儿童正在接受手术或诊断程序，而这些手术或诊断程序以前被认为不适合门诊手术。儿科门诊手术的增加，再加上最近儿科麻醉医生短缺，这意味着许多儿童将接受普通临床医生的麻醉护理，这些医生只是间歇性地照顾儿童，可能不熟悉这些合并症可能带来的围手术期风险。
预计我们的儿科门诊手术人群中肥胖症和SDB/OSA的发病率会不断上升。关注与这些合并症相关的潜在围手术期并发症可为制定各个门诊中心的标准提供更坚实的基础。这有助于进行有针对性的麻醉管理，影响医护人员的分配和/或人员配备比例，并为安排手术时间提供参考。对于并非每天都从事儿科麻醉工作的麻醉医生来说，了解预期情况对于消除意外情况并安全护理这些患者的能力起着重要作用。
