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Principles II N517 > Ambulatory Anesthesia and Surgery > Flashcards

Ambulatory Anesthesia and Surgery Flashcards

1
Q

What are some benefits of ambulatory surgery?

A

Patient preference (children and elderly)
Bed availability
Flexibility in scheduling surgery
Low morbidity/mortality
Lower incidence of infection
Lower incidence of respiratory complications
Greater efficiency/more patients
Shorter surgical waiting lists
Lower procedural costs
Less preoperative testing/postoperative medication

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2
Q

What is SAMBA?

A

Society for Ambulatory Surgery and Anesthesia - recognized anesthesia society that regulates ambulatory surgery

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3
Q

What advances in medicine have been made to benefit ambulatory surgery?

A
  • Rapid onset, shorter acting drugs (anesthetic agents, analgesics, short-acting muscle relaxants)
  • Minimally invasive surgical procedures (laparoscopic/arthroscopic)
  • Pulse oximetry (standard of care since 1990)
  • EtCO2 (standard of care since early 1990’s)
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4
Q

What is a hospital integrated ambulatory surgical unit?

A

Inpatient facility that has outpatients with a separate pre-op and recovery area

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5
Q

What is a hospital-based ambulatory surgical unit?

A

Separate ambulatory surgery center within the hospital that only does outpatients

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6
Q

What is a freestanding ambulatory surgical unit?

A

Facility that is associated with a hospital or medical center but housed in a separate building for all outpatient procedures

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7
Q

What is an office-based ambulatory surgical unit?

A

Outpatient surgical center used in conjunction with physician offices for the convenience of patients and healthcare providers

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8
Q

How much of all elective surgery is performed in an outpatient setting?

A

60-70%

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9
Q

What types of procedures are done in an outpatient setting?

A 
ENT
Plastics
Oral/maxillofacial
General surgery (lap/non-lap procedures, GYN procedures)
Orthopedics
Eyes
Pain management
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10
Q

What are some pre-op considerations for ambulatory surgery?

A 
Phone interview vs. live interview
lab tests
Instructions: clear and REPETITIVE
Responsible party with them
NPO rules
Which meds to take/not take
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11
Q

With which patients would it be appropriate to do a phone interview?

A

ASA 1 adults and parents of ASA 1 peds
ASA 2-3 adults with well-controlled diseases and parents of ASA 2-3 peds
ASA 3-4 for cataract extraction/lens implant

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12
Q

WIth which patients would you want to do a live interview?

A 
ASA 3-4 with questionable disease control
Known or suspect difficult intubation
Complex syndromes (mental disabilities)
Patient having airway surgery for OSA
Language barriers
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13
Q

Which patients are not appropriate for ambulatory surgery?

A

ASA 4, but some exceptions can be made for ESRD patients or COPD patients coming in for minor procedures using little anesthesia

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14
Q

What pre-op lab tests would you do for patients

A

No testing required

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15
Q

What lab do OB/GYN’s often order for their patients?

A

H/H on menstruating females or those with history of increased uterine bleeding

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16
Q

What patients require an EKG pre-op?

A

Anyone over 50 yo, although ASA feels age alone is not indication for EKG and it should be based on history and physical exam

17
Q

What patients require a CBC pre-op?

A

All patients >60 yo

18
Q

Can pre-op lab protocols/policies vary from institution to institution?

A

Yes

19
Q

What patients require a CXR pre-op?

A

those with significant pulmonary or CV disease, malignancy, or as a baseline for intrathoracic surgery

20
Q

With what procedures would you want to do a urinalysis before?

A

Hardware insertion (stents) or suspected UTI

21
Q

Who decides if a patient needs medical clearance regarding a certain condition?

A

We do. We have to use our own judgement based on how severe the patient’s disease is and the value of the clearance (is it going to change your anesthetic plan)

22
Q

What is involved with patient preparation before ambulatory surgery?

A
  • Proper introductions/verifications (right patient, right surgery/surgeon, allergies confirmed, NPO status confirmed, responsible party present and able to drive them home)
  • Informed consent (anesthetic options, anesthetic risks)
  • Explanations as you go (IV insertion, PONV prevention/treatment, pain prevention/treatment)
  • Anxiety relief (non-pharmacologic, pharmacologic)
23
Q

What drugs can we give for PONV prevention?

A 
Steroids
Serotonin antagonists
Droperidol/Butyrophenones
Metoclopramide
Scopolamine patch
Compazine
Dramamine
ADEQUATE VOLUME ADMINISTRATION
24
Q

What patients are at increased risk for aspiration?

A

obesity
DM
GI disorders

25
Q

What GI disorders can put someone at increased risk for aspiration?

A

Mendelson’s syndrome
Decreased LES tone
Hiatal hernia
GERD

26
Q

What is mendelson’s syndrome?

A

aspiration from volume >25 mL with pH

27
Q

What drugs can be given for aspiration prevention?

A
  • H2 receptor antagonists (ranitidine/zantac)
  • Dopamine receptor antagonists (Metoclopramide/Reglan)
  • Non-particulate oral antacids (Bicitra and Na Citrate, use with Reglan for immediate onset)
28
Q

What is the most important consideration during pre-induction/induction?

A

have emergency plan

29
Q

What things should you be doing during maintenance for an ambulatory surgery?

A
  • Watch the surgery and the patient
  • Be proactive to prevent PONV and post-op pain
  • Talk to the surgeon and OR staff for what’s going on, timing…
  • Prepare for the next patient
30
Q

What should you consider during emergence?

A
  • minimal bucking/coughing
  • smooth but rapid wake-up
  • safe/patent airway
  • patient able to assist movement to stretcher
  • fast room turnover (10 minutes or less)
31
Q

What should you be doing while transporting your patient to PACU?

A
  • talk to them during transport
  • constantly assess potential for vomiting (see if they are constantly swallowing)
  • constantly assess airway patency and respiratory effort
  • assist PACU nurses with monitor placement while giving report
32
Q

What things should your PACU report include?

A

Surgery performed with any pertinent info
Important disease processes
Sedatives
Narcotics
Drugs for PONV prevention
Unusual events requiring intervention (HTN, HoTN)

Principles II N517 (7 decks)

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