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.  
Introduction Day 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 difficulties were
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