Outpatient Anesthesia Flashcards
What are the advantages for outpatient anesthesia?
COST -Moedical cost -Cost of the family -Third party payers review/identify procedures suitable for outpatient to reduce costs MEDICAL -Increase number inpatient beds -Decrease exposure to nosocomial infection SOCIAL -Minimize interruption of ADL -Continued care from caregiver or family members STAFFING -Predictable surgical outcomes -More uniform schedule -Time utilization efficient
What are the disadvantages of outpatient anesthesia?
- Privacy may be decreased/compromised
- Screening may require multiple tirps
- Adequate care at home
- Patient compliance
- Decreased time for orientation/adaptation
- Decreased observation post-op
What are the demographic considered for outpatient anesthesia?
- 30 % less than 12 y/o
- 10 % greater than 65 y/o
- Premature babies are the exception of outpatient anesthesia
What is the surgical time length of outpatient surgery?
- Usually less than 2 hour
- Rare to exceed 4 hours
What are characteristics of an acceptable outpatient procedure?
- Minimal blood loss and fluid shifts
- Surgeon skill
- Postoperative pain/immobilization
- Facility to facility abilities
What is the most common procedure at outpatient surgeries?
Opthalmologic
What is the second most common precedure at outpatient surgery?
Gynecological
What shold be considered for every patient?
- Acute substance abuse
- Age
- Convulsive disorder
- Morbid obesity
- Reactive airway
- Sickle cell disease
- Social consideration
- Cystic fibrosis
Patient with substance abuse considerations are?
- evaluation day of surgery
- Cancellation of acute/intoxicated drug abuse
- Consideration of regional technique with use of NSIADS to reduce opioid use
- Discussion of pain management with the patient
What are the unacceptable characteristics in a premature infant ?
UNACCEPTABLE -anemia -Underdeveloped gag reflex -Immature temperature control -Apnea (OF NOTE IN PEDS COURSE INFANTS SHOULD NOT BE CONSIDERED UNTIL OR AFTER 50 - 60 WEEKS POST CONCEPTION)
Important points on apnea of the premature infant.
- Short (6-15 seconds)
- Prolonged (greater than 15 seconds)
- Periodic breathing (3 or more period of apnea of 3-15 seconds separeated by < 20 seconds of normal breathing
- Can develop as late as 12 hours post op
T/F: Considering physiologic not chronologic age of a geriatric patient is important.
TRUE
T/F: Geriatric patient greater than 85 years of age are at less risk for hospital admisison and death within the week following week of surgery?
FALSE
Convulsive disorder in the outpatient surgery:
- Schedule early in the morning to allow longer observation of up to 4 to 8 hours post op
- Ensure proper delivery of anticonvulsant medication
- Uncontrolled seizure activity is not acceptable in the outpatient setting
Cystic fibrosis in the outpatient surgery:
- Pulmonary function is the primary predictor
- Ability to manage respiratory distress and hydration
Morbid Obesity in the outpatient surgery:
- Candidate are ASA 1 & 2
- Comorbidities such as cardiac endocrine hepatic renal or pulmonary should be inpatient
- Increase risk for difficult airway and sleep apnea
Reactive airway disease in the outpatient surgery:
-Base line status and severity determined prior to suregery
-patient should not experience acute symptoms
-Continue meds until time of surgery
-expect possible admissions
-
Sickle cell disease in the outpatient surgery:
- may occur if patient subject to hypoxia, acidosis, dehydration
What are the criteria for outpatient if patient has sickle cell disease?
- No major organ disease
- No sickle cell crisis for 1 year
- Compliant medical history
- Early appointment
History and physical for a stable patient should be within __ days or within __ hours for the high risk patient.
30
72
Lab values are good within __ days of surgery if patient is stable.
60
If a patient is on diuretic/digitalis a potassium must be drawn within how many days?
7
If coumadin is withheld it should be a minimum of _ to _ day and restarted _ to _ day after surgery.
4 to 5
1 to 7
How long after should surgery be rescheduled for a upper respiratory tract infection?
4 weeks
When is fluid management considered?
- Surgery longer than 30 minutes
- Increased PONV
- Increased post op pain
- Prolonged fasting
- Bleeding
- antibiotics
What are contributors to PONV?
- Ambulation
- Postural hypotension
- Uncontrolled pain
- post op pain meds
- oral intake
- Low inspired O2 concentration
- Reversal agent
What is seen in Phase 1 after surgery?
- Stable VS
- No resp. impairment
- Protective airway reflexes
- Patient oriented to preoperative level
What is seen in Phase 2 after surgery?
- Ambulation assistance
- No resp distress
- Bleeding minimal
- pain controlled
- PONV minimal
- Oral intake
- Voiding
- Caregiver present
T/F: MAC has a higher incidence of brain damage and death than general or regional anesthesia.
TRUE
What is deep sedation?
- Patient unable to be easily aroused
- Responds appropriately to pain
- May need assist to maintain airway
What is minimal sedation?
- Patient responds verbally but cognitive function may be impaired
- Resp/CV function unchanged
What is moderate sedation?
- Physician can direct
- Patient should not be allowed to loose protective airway reflexes
What is the first line of treatment for laryngospasm?
-Positive airway
Second option is Succinylcholine 0.1 mg/kg IV
What are the pharmacology options for blood loss management of a D&C?
-Methylergonovine maleate (Methergine)
(0.2 mg/IM)
_Oxytocin(Pitocin)
(10-20 units/IV
T/F: Methylergonovine mateate (Methergine) can be given to the patient with preeclampsia.
FALSE
With cervical dilitation your patient becomes bradycardic and hypotensive; why and the treatment?
- Vasovagal response
- Release of cervix and treatment with atropine 0.4 mg IV if needed
What is the adequate level for a hysteroscopy?
-T10
T/F: Nasotracheal tube is preferred placement in dental surgeris.
TRUE
Damage to lingual nerve during surgical tooth extraction will cause numbness to:
Tongue
Damage to inferioralveolar nerve during surgical tooth extraction will cause numbness to:
Lip
T/F: Nasal airway should NOT be placed for difficult mask ventilation of a tonsilectomy/adenoidectomy.
TRUE
Adult patient arries for T&A that has fever, nasal secretions, purlent sputum. Do they have the surgery?
No, they show signs of URTI
What is the post op position of the T&A patient?
Tonsilar position (Lateral, head down posstion)
What is the most common complication of knee arthroscopy?
-Hemarthrosis
