Ambulatory Anesthesia & Surgery Flashcards
Why might it be beneficial for an elderly patient or a pediatric patient to receive surgery in an ambulatory setting?
They are able to go home to a familiar setting
What association set the guidelines for ambulatory surgery?
Society for Ambulatory Anesthesia
What was the impact on anesthesia from having more ambulatory surgery centers?
Rapid onset, shorter acting drugs
Minimally invasive surgical techniques
Pulse oximetry
EtCO2
When was the pulse oximeter made into a standard of care for patients receiving anesthesia?
1990
What opioids were introduced with the movement to make drugs more rapid and shorter acting?
Sufentanil
Remifentanil
Fentanyl
What NMBA were introduced with the movement to make drugs more rapid and shorter acting?
Vec
Roc
Cis
What Volatiles were introduced with the movement to make drugs more rapid and shorter acting?
Desflurane
Sevoflurane
What were majority of the readmissions/ER visits related to post ambulatory surgery?
Surgical complications
What type of surgery has the highest incidence of readmissions/ER visits?
ENT
What type of surgery has the lowest incidence of readmissions/ER visits?
GYN
About what percentage of elective surgeries today are done in the outpatient setting?
60-70%
What is an appropriate way to deliver preoperative instructions?
To the patient and family member that will be assuming care try to be clear and repetitive
Why is it essential that the patient have a responsible party with the day of surgery?
To drive the patient home and care for them post operatively
What ASA categories is it appropriate to do a phone interview preoperatively?
ASA 1
ASA 2&3 with well controlled disease
What is one of the only scenarios that it would be appropriate to interview an ASA 4 over the phone?
Cataract extraction/lens implant, however not appropriate at an ambulatory center
What type of patients require a live interview?
ASA 3-4 with questionable disease control
Known or suspected difficult intubation
Airway surgery for OSA
Language barriers
What lab might an a OB/GYN order prior to surgeries?
HH if uterine bleeding is reason for surgery or heavy menstruation
At what age would healthy individuals not require routine preoperative testing?
Less than Age 50
What test is required for all individuals over the age of 50?
EKG, however should be based on history and physical (ASA does not feel age alone requires EKG)
What laboratory study is done for all patients over the age of 60?
CBC
When would a CXR be required for preoperative testing?
Significant pulmonary or CV disease
Malignancy
Baseline for intrathoracic surgery
When would a urinalysis be required for preoperative testing?
Hardware insertion (stents) Suspected UTI
What disease processes would a provider want a baseline chemistry on the patient?
HTN
DM
What does it mean when a patient requires clearance prior to surgery?
Requiring another service to clear the patient for surgery (cardiology, nephrology)
What puts a patient at risk for aspiration?
Obesity
DM
GI disease
What is Mendelson’s syndrome?
Aspiration of volume >25mL with a pH
What causes Mendelson’s syndrome?
GERD
Hiatal hernia
Decreased LES tone
What can be given to a patient to prevent aspiration?
H2 receptor antagonists
Dopamine receptor antagonists
Non-particulate oral antacids
What are desirable qualities for a smooth emergence?
Minimal bucking/coughing Smooth but rapid wake-up Safe patent airway Patient able to assist in move to stretcher Fast room turnover
What should the provider be looking for while transferring a patient to determine if they are going to get sick?
Lots of swallowing repetitive and frequent
