Table 2 Pre-Operative phase

Family or Social Status excluding Day Surgery

Parents reluctant or unable to take care of the child in the post-operative period at home. Poor domestic hygienic conditions. Lack of a telephone. House more than 1 h travelling distance from an hospital provided with a 24 h emergency facility. Absence of public transport

V

A

[122,123,124,125,126,127]

Newborns

Full term newborns (Gestional Age Weeks > 38) of less than 1 month are excluded from Day Surgery. Exclusion should be preferably extended to at least 6 months of age. Infants from 2 to 6 months age could be included according to Structure Policy and Surgical Grading.

V

A

[18, 128,129,130,131,131]

ASA III Patients

Normally excluded from Day Surgery. May possibly be eventually included in relation to low surgical grading procedures. There needs to be, at any rate, a prolonged observation post-operatively before discharge.

III

C

[132, 133]

Patient with current Upper Respiratory Infection (URI)

Procedure must be postponed in relation to patients with major respiratory symptoms. If there are mild or moderate symptoms the procedure should be postponed if the child is of less than 1 year of age. In the case of older patients the risk factors should be considered and the appropriacy of the operation assessed in each case.

II

A

[134,135,136]

Pre-Term

Infants PCA > 60 weeks. Clinically Stable. Anemia corrected.

II

A

[2, 137,138,139,140]

Evaluation of Timing

No pre-anesthesia assessment much in advance. An assessment is advisable shortly before the procedure.

V

B

[141,142,143,144,145]

Lab Tests

Routine Lab Tests in healthy patients older than > 1 yr. have a low predictive value

I

A

[146,147,148,149,150,151]

Medical Records

A parental anamnestic questionnaire is a good tool before any surgical procedure.

IV

C

[152]

Pre-operative Fasting

The administration of clear fluids up to two hours before induction is advised. This lower the residual gastric volume and raise pH.

I

A

[153,154,155,156]

Prevention of Nausea and Post-Operatory Vomiting (PONV)

PONV prevention requests a multifactorial approach that includes pre-operative identification of risk factors (family history, age > 3 yrs., Strabismus Repair and ORL surgery). In patients at risk prophylaxis is recommended (i.e.ondansetron 0.05 mg/kg + dexametason 0.015 mg/kg).

I

A

[157, 158]