RT Book, Section
A1 Mayers, Douglas B.
A1 Haas, Judith
A1 Convery, Ellen
A2 Longnecker, David E.
A2 Brown, David L.
A2 Newman, Mark F.
A2 Zapol, Warren M.
SR Print(0)
ID 56649945
T1 Chapter 68. Outpatient Anesthesia
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56649945
RD 2024/04/16
AB The  location  for  an  outpatient  surgical  procedure  can  be  either  in  a  hospital  or  in  a  freestanding  outpatient  surgery  center.  The  organizational  structure  for  outpatient  surgery  centers  is  determined  by  their  location  in  relation  to  a  hospital  and  their  governance  model.Evaluation  of  patients  in  preparation  for  outpatient  surgery  involves  the  usual  standards  plus  the  added  issue  that  the  patient  is  expecting  to  go  home  the  same  day.  Thus,  the  patient  must  be  undergoing  a  procedure  appropriate  for  same-day  discharge  and  must  be  physiologically  able  to  go  home.There  is  no  standard  "best  anesthetic"  for  outpatient  surgery.  An  anesthetic  plan  must  consider  the  planned  procedure  and  the  patient's  physiology  in  addition  to  surgeon,  anesthesiologist,  and  patient  preferences.  The  drugs  and  modalities  are  chosen  for  effectiveness  and  speed  of  emergence  in  addition  to  safety.Although  major  morbidity  and  mortality  are  rare  and  hospital  admissions  and  readmissions  uncommon,  minor  morbidities,  especially  of  pain  and  postdischarge  nausea  and  vomiting,  continue  to  pose  significant  challenges.Combination  prophylaxis  and  treatment  of  postoperative  nausea  and  vomiting  is  probably  the  most  effective  approach  combined  with  adequate  hydration  and  the  least  emetogenic  anesthetic  possible  for  a  given  procedure.Multimodal  opioid  sparing  pain  management  is  most  effective  and  enhances  patient  satisfaction  and  well  being.  Widespread  use  of  ultrasound  technology  has  led  to  improved  efficiencies  in  the  performance  of  peripheral  nerve  blocks  and  should  remove  as  a  barrier  to  their  performance  the  belief  that  an  outpatient  surgery  unit  cannot  afford  their  inefficiencies.The  pediatric  patient  population  has  special  needs  requiring  family-centered  education  about  the  entire  perioperative  practice.  A  quiet  area  for  recovery  benefits  not  only  the  child  but  also  the  recovering  adult  patients.Although  obese  patients  and  patients  with  obstructive  sleep  apnea  are  challenging,  with  appropriate  selection  of  patient  and  procedure  as  well  as  careful  management,  these  patients  once  thought  unsuitable  for  outpatient  surgery  are  now  safely  enjoying  its  benefits.