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The lower age limit for day surgery will depend on the facilities and experience of staff and the medical condition of the infant. Ex-preterm infants should generally not be considered for day surgery unless they are medically fit and have reached a postmenstrual age of 60 weeks. Risks should be discussed with parents and carers on an individual basis.
Parents, carers, children and young people should be provided with good quality preoperative information, including information on fasting and on what to do if the child becomes unwell before the operation. Postoperative analgesia requirements should be anticipated, and discussed at the preassessment visit.
Specific guidance for the prevention and treatment of postoperative nausea and vomiting in children and young people should be available.44
There should be clear documented discharge criteria following day case surgery.
Discharge advice should be detailed and carefully worded to facilitate ongoing care by parents or carers.
A local policy on analgesia for home use should be in place, with either provision of medications, or advice to parents and carers before admission to purchase suitable simple analgesics. In both instances, there should be clear instructions to parents and carers about their regular use in the correct dose and for a suitable duration. Parents and carers should be...
Neonates, infants and children who are likely to require critical care following an operation should undergo their surgery in a hospital/unit with a designated PICU or NICU.39,41
If the patient is too sick to transfer to such a hospital prior to surgery and their current hospital has surgeons capable of operating, then transfer should occur as soon after surgery as is clinically appropriate.13
The decision on the most appropriate place for the treatment of a teenager or young person should be made on an individual basis, balancing the expertise of the clinician in the patient’s condition against any effort to fully separate adult patients from teenagers. Local operating policies should be in place to support this decision.
Where treatment is carried out in facilities normally used by adult patients, such as obstetric units or for patients requiring ECT treatment, guidelines should be in place for staff training and organisation of services.45,46
