Outpatient/Office Surgery Flashcards
Today’s trends in anesthesia
80% outpatient
$$ primary incentive for amb/office surgery
Meds- shorter acting
When to perform safe surgery checklist
How many periods
- Prior to admin of anesthesia
- Prior to skin incision
- Period of closure of incision & prior to pt leaving the OR
SCIP measure
- Temp
- Abx
- Beta blockers
What is the goal of pre op eval
Identify at risk pts
Who gets EKG
> 50 & has comorbidity or >50 & more invasive procedure
What meds not to take day of surgery
Diuretics MAO Anticoagulant: Coumadin 5 days, plavix 7 days PO DM meds Herbal meds Viagra, ETOH, cigarettes
Which herbs potentials bleeding
Ginkgo, garlic, ginger, fish oil
Hypokalemia is caused by what herb
Licorice
Cardiac instability - herb??
Ephedra
Prolong sedation herb
Kava
Decrease BP herb
Black cohosh
Increase BP, agitation, drowsiness
St. John’s wort
CVA & MI criteria for ASC
CVA within 3 months
MI 0-3 months not in office
MI 3-6 moths needs clearance
Geriatric pt
Physiologic age, not chronologic
Pediatrics pt
Gestation >37 weeks healthy
>2-4 weeks old then OS is ok
Preemies pt not recommended if
Preemie with post conceptual age of
Monitoring for infants
STOP
BANG
Snore
Tired
Observed that u stopped breathing
Pressure, high BP
BMI >35
Age >50
Neck circumference >40cm or 15.75 in
Gender male
When do most OSA complication occur and waht to anticipate
Within 2 hrs of surgery
Anesthesia increases the number & duration of apnea periods
Anticipate longer phase II recovery stay
Median post d/c observation is 7 hrs
What surgery to schedule first in am
Convulsive disorder
MH
DM 1
These pt need to be observe 4 hrs after surgery
How long should surgery be delayed if URI present
Until 6 weeks have elapsed
Fasting guidelines for healthy pt undergoing elective surgery
2 hrs - CL
4 hrs - breast milk,
6 hrs - formula, milk, light meal
Common complication - delay of discharge
PONV 20-30% Urinary retention Hypothermia Poor pain control Itching Sore throat
Aldrete subgroups
Respiration O2 sat Consciousness Circulation Activity
Airway equipment needed for offsite locations
Always: oxygen, sx, O2, ambu bag
Monitoring for transfer if unstable
Office accreditations
JACHO
AAAHC
AAAASF
The most common cause r/t injury/death
Inadequate ventilation/oxygenation
Lipo consideration
EBL 1% of aspirat
Limit to 5000 ml –1% —50 ml
Peak plasma lido —- 12-14 hrs after injection
What ASA for office procedures
Waht is the minimal age
Healthy 1 & 2
> 3 years old
Office surgery contraindications
Lipo/tumescent both >5000 ml Multiple procedures with abdomoplasty Anticipated blood loss >500ml Surgery > 6 hrs Unable to complete case by 3pm
How to calculate O2 tank, remaining time
Time in Hrs = Oxygen cylinder pressure/200 x O2 flow rate(L/min)
Time in min = 0.35 x psi on gauge/L per min to be delivered
Disadvantages of office based practice
- No consistent regulatory oversight
- Crna responsible for maintainance
- No emergency backup
- Crna must be aware of state regulations
Most common procedure outpatient
Cataract
