ambulatory surgery 3/24

Question 0

how long should a case at the ASC be?

Answer 0

less than 2 hours

Question 1

1. what type of procedures

2. what is criteria for ambulatory surgery?

Answer 1

1. orthopedic, laparoscopy, pediatric, general surgery (hernia, biopsies), eyes, ent, ears, plastics, gyn
2. should be ASA 1 or 2

Question 2

what diseases require pre treatment for surgery at ASC?

Answer 2

• seizures
• sickle cell
• MH
• reactive airway (ashtma/ bronchitis)
• obstructive sleep apnea
• diabetes
• recent bleeding issues with surgery
• ponv
• concurrent illness

Question 3

1. how much o2 does an E tank hold?

2. how much does an H tank hold?

Answer 3

1. ~2,000 Liters

2. 10X that or 20,000 L

Question 4

how to estimate o2 remaining cylinder time in hours:

Answer 4

oxygen cylinder pressure (PSIG)
——— (divided by)—————–
200 x oxygen flow rate (L/min)

Question 5

herbal remidies that cause bleeding

Answer 5

• ginsing
• garlic
• ginkoba
• fish oil

Question 6

new monitoring technologies:

Answer 6

remote cardiac monitors

Question 7

liposuction:

1. how much can be removed?
2. what is tumescence?
3. how much can be instilled?
4. what is the EBL% of any amount of aspirant?

Answer 7

1. less than 5 liters of fat
2. saline with lidocaine (0.25-1%) and epinephrine (1:1,000,000) in it to control bleeding
3. less than 5 liters of tumescence can be instilled (1-4 ml tumescent for every 1 ml fat).
4. EBL is only 1% of the total aspirant

Question 8

what patient may need rescheduling or to go to a main OR?

list 10

Answer 8

1. recent MI
2. signs of cardiac failure
3. ASA 3 or 4
4. severe systemic disease
5. BMI > 40
6. baby born premature with patient conceptual age less than 50-60 weeks
7. baby under 6-12 mos with history of SIDS
8. really old and look it
9. gestational age less than 37 weeks and less than 2-4 weeks old
10. recent URI (snots ok in ENT patients as long as it is not green).

Question 9

1. number 1 reason for prolonged stay post op?

2. what predisposes one to this?

Answer 9

1. eye surgery
   
   • tonsils
   • ear
   • orchiectomy
   • laparoscopic/ young/ female /non smokers/ menstruating or in 1st trimester
   • hx. motion sickness

Question 10

absolute contraindications to office procedure: (13)

Answer 10

1. poorly controlled systemic disease
2. mod to severe OSA
3. morbid obesit
4. MI in last 6 mos
5. CVA in last 3 mos
6. no adult escort
7. pacer or AICD
8. acute substance abuse (drunk or high)
9. MH history
10. sickle cell disease
11. M.Gravis
12. less than 3 yrs old
13. unstable psych hx.

Question 11

role of standards:

Answer 11

protect patient and you???