Are
there any patients who should never have surgery on an ambulatory basis?
An exception to the list of acceptable
candidates is ex-preterm infants who are less than 55–60 weeks post-conceptual
age. These patients may have life-threatening episodes of postoperative apnea
and bradycardia as many as 12 hours and up to 48 hours after receiving a
general anesthetic. Therefore, in-hospital monitoring of these patients is
recommended. For similar reasons, term infants less than 44 weeks
postconceptual age should also have surgery performed only on an inpatient
basis. Postoperative respiratory monitoring is mandatory for at least 12–18
hours. If at all possible, any required surgery or diagnostic proce-dures
requiring the administration of either a sedative or a general anesthetic
should be postponed until the child passes this period.
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