Ambulatory Anesthesia & Surgery

Question 1

Why might it be beneficial for an elderly patient or a pediatric patient to receive surgery in an ambulatory setting?

Answer 1

They are able to go home to a familiar setting

Question 2

What association set the guidelines for ambulatory surgery?

Answer 2

Society for Ambulatory Anesthesia

Question 3

What was the impact on anesthesia from having more ambulatory surgery centers?

Answer 3

Rapid onset, shorter acting drugs
Minimally invasive surgical techniques
Pulse oximetry
EtCO2

Question 4

When was the pulse oximeter made into a standard of care for patients receiving anesthesia?

Answer 4

1990

Question 5

What opioids were introduced with the movement to make drugs more rapid and shorter acting?

Answer 5

Sufentanil
Remifentanil
Fentanyl

Question 6

What NMBA were introduced with the movement to make drugs more rapid and shorter acting?

Answer 6

Vec
Roc
Cis

Question 7

What Volatiles were introduced with the movement to make drugs more rapid and shorter acting?

Answer 7

Desflurane

Sevoflurane

Question 8

What were majority of the readmissions/ER visits related to post ambulatory surgery?

Answer 8

Surgical complications

Question 9

What type of surgery has the highest incidence of readmissions/ER visits?

Answer 9

ENT

Question 10

What type of surgery has the lowest incidence of readmissions/ER visits?

Answer 10

GYN

Question 11

About what percentage of elective surgeries today are done in the outpatient setting?

Answer 11

60-70%

Question 12

What is an appropriate way to deliver preoperative instructions?

Answer 12

To the patient and family member that will be assuming care try to be clear and repetitive

Question 13

Why is it essential that the patient have a responsible party with the day of surgery?

Answer 13

To drive the patient home and care for them post operatively

Question 14

What ASA categories is it appropriate to do a phone interview preoperatively?

Answer 14

ASA 1

ASA 2&3 with well controlled disease

Question 15

What is one of the only scenarios that it would be appropriate to interview an ASA 4 over the phone?

Answer 15

Cataract extraction/lens implant, however not appropriate at an ambulatory center

Question 16

What type of patients require a live interview?

Answer 16

ASA 3-4 with questionable disease control
Known or suspected difficult intubation
Airway surgery for OSA
Language barriers

Question 17

What lab might an a OB/GYN order prior to surgeries?

Answer 17

HH if uterine bleeding is reason for surgery or heavy menstruation

Question 18

At what age would healthy individuals not require routine preoperative testing?

Answer 18

Less than Age 50

Question 19

What test is required for all individuals over the age of 50?

Answer 19

EKG, however should be based on history and physical (ASA does not feel age alone requires EKG)

Question 20

What laboratory study is done for all patients over the age of 60?

Answer 20

CBC

Question 21

When would a CXR be required for preoperative testing?

Answer 21

Significant pulmonary or CV disease
Malignancy
Baseline for intrathoracic surgery

Question 22

When would a urinalysis be required for preoperative testing?

Answer 22

Hardware insertion (stents)
Suspected UTI

Question 23

What disease processes would a provider want a baseline chemistry on the patient?

Answer 23

HTN

DM

Question 24

What does it mean when a patient requires clearance prior to surgery?

Answer 24

Requiring another service to clear the patient for surgery (cardiology, nephrology)

Question 25

What puts a patient at risk for aspiration?

Answer 25

Obesity
DM
GI disease

Question 26

What is Mendelson’s syndrome?

Answer 26

Aspiration of volume >25mL with a pH

Question 27

What causes Mendelson’s syndrome?

Answer 27

GERD
Hiatal hernia
Decreased LES tone

Question 28

What can be given to a patient to prevent aspiration?

Answer 28

H2 receptor antagonists
Dopamine receptor antagonists
Non-particulate oral antacids

Question 29

What are desirable qualities for a smooth emergence?

Answer 29

Minimal bucking/coughing
Smooth but rapid wake-up
Safe patent airway
Patient able to assist in move to stretcher
Fast room turnover

Question 30

What should the provider be looking for while transferring a patient to determine if they are going to get sick?

Answer 30

Lots of swallowing repetitive and frequent