Ambulatory Surgery最新文献

To assess to what extent day case surgery for breast cancer is practised in the Netherlands a questionnaire was sent to 105 surgeons/hospitals. In 2004, 30% of the hospitals performed minor and 3% performed major breast cancer surgery in a day case setting. Sixteen percent of the hospitals indicated planning to introduce day case surgery for minor and major breast cancer surgery. The basic requirements for this development are widely available. Potential obstacles can be overcome by adjustments in organisation, logistics and financial reimbursement, thus making day case surgery available to more patients while reducing health care costs.

Though many physicians do not think of themselves as leaders, anesthesiologists working in an ambulatory surgery center have a unique opportunity and indeed, a responsibility to exert leadership in a way that will positively impact the working environment. This article examines the pitfalls of different leadership styles frequently employed by physicians and the role of emotional intelligence in the ASC. The author offers practical advice on why and how to manage emotional outbursts in the operating room that can lead to stress, poor performance and may even threaten patient safety.

The 5th James H. Nicoll Memorial lecture was delivered at the 5th International Congress on Ambulatory Surgery, Boston, Massachusetts, 2003. A summary of historic events and modern concepts of care for the ambulatory surgical patient is summarized. Current guidelines of the American Society of Anesthesiologists were developed using an evidence-based model. Data, however, are lacking and conclusions based largely on consensus of experts. Morbidity and mortality are low frequency events. Large populations must be studied to identify and correct causative factors. Data from recent studies are noted and critiqued. Office-based surgery is a specific venue of concern.

In this article some factors that influence the safety of anesthesia care for infants and children are reviewed. In particular elements of training and ongoing experience necessary for the safe provision of pediatric anesthesia care are identified and also the necessary support needed in terms of personnel and facilities. Several guidelines relating to the provision of pediatric anesthesia care are reviewed. Finally, those infants and children who are at increased anesthetic risk are identified. It is essential that the needs of these at risk patients and the capabilities of the provider and facility are matched.

Objectives:

The aim of this study was to determine whether a combination of paracetamol and diclofenac provided a more effective analgesic premedication than paracetamol, or diclofenac alone for the treatment of postoperative pain following surgical suction termination of early pregnancy.

Methods:

A double blind, prospective trial, involving 60 patients randomized to receive either paracetamol (1 g) and placebo, diclofenac (50 mg) and placebo, or diclofenac (50 mg) and paracetamol (1 g) orally, prior to surgical termination of pregnancy. Intraoperative management was standardized. Peak pain was the primary end point. Pain scores were recorded immediately postoperatively, and at 2 and 4 h. Secondary end points were nausea, sedation, intraoperative blood loss, supplementary postoperative analgesic use, and delayed hospital discharge.

Results:

There was no statistically significant difference in peak pain between the three groups (P = 0.6).

Discussion:

The co-administration of prophylactic oral analgesic premedication with diclofenac and paracetamol did not result in a reduction in pain scores when compared to either diclofenac or paracetamol administered alone.

Purpose:

This blinded study evaluates the N₂O concentration variations in an ambulatory surgery centre using a small, simple on-line trace gas concentration monitor (GasFinder™ [Medair AB, Delsbo, Sweden]).

Scope:

Thirty-seven day surgical sessions using standardised anaesthesia with propofol/fentanyl induction and sevoflurane/N₂O with larynx mask. Five of 37 time-weighted averages (TWA) were greater than 25 ppm but less than 100. Peak registered concentrations reached 2000 ppm. Eleven sessions showed peak values higher than 100 ppm (range 13–1693).

Conclusions:

This simple, on-line N₂O monitor is a useful tool for detecting deviations from strict gas hygiene.

This article will provide information that can be used to create or enhance the position of a medical director in a surgical suite. Included are role descriptions and distinctions. Lists of tasks or responsibilities are also provided, along with a model that may be useful for medical director selection, development, and evaluation.

Background:

The aim of our study was to review our experience and to determine preoperative predictive factors for ambulatorization of laparoscopic cholecystectomy (LC).

Methods:

Between January 1999 and June 2002, 305 consecutive LC were performed as outpatient procedures. We performed univariant and multivariant analysis of preoperative clinical, analytical and ultrasonographic variables. The preoperative scoring system developed allowed us to calculate the ambulatorization probability of LC in each individual patient.

Results:

265 patients were strictly ambulatory (86.8%). Thirty-five patients required overnight admission (11.4%), most of them due to social factors, and five patients were admitted. Preoperative factors related to overnight stay or admission were: age over 65 years (p = 0.011), past history of biliary complications (p = 0.001), previous admission due to complicated biliary disease (p = 0.001), previous supramesocholic abdominal surgery (p = 0.011) and ultrasonographic findings of gallbladder thickened wall and/or shrunken gallbladder (p = 0.041). Right classification index of the predictive system was 87.5% reaching a sensibility of 87.8% and specificity of 56.6%.

Conclusions:

Outpatient LC is safe and feasible. Age, previous biliary history and ultrasonographic findings are independent preoperative factors influencing ambulatorization rate.