Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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The most common fear expressed by preanesthesia patients is experiencing awareness while under general anesthesia. Although extremely rare, awareness during anesthesia does occur and patients have recalled explicit details and conversations that occurred while they were under general anesthesia, including described recall of the intubation process. The Bispectral Index Monitor (BIS) was developed by Aspect Medical System of Newton, MA, to measure patient response to the administration of potent sedative, hypnotic agents. The BIS monitor is intended to decrease the risk of intraoperative awareness by providing the anesthetist with a quantitative assessment regarding the hypnotic state of the patient.
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Elective surgical procedures are moving from hospital-affiliated and freestanding ambulatory centers to the physician office. Anesthetic risk has decreased dramatically during the past decade; however, perioperative safety is ill defined when the surgical procedure is performed in the physician office. ⋯ Regulation of office-based surgery is now being addressed by specialty organizations and Departments of Health or Boards of Medical Examiners. A comprehensive study of perioperative risk for patients receiving office-based surgical care is needed.
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J. Perianesth. Nurs. · Dec 2001
ReviewPatient care after discharge from the ambulatory surgical center.
An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery. ⋯ -Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.
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The fast-tracking recovery concept examines different paradigms for streamlining the postoperative recovery process. Fast-tracking anesthetic techniques allow suitable outpatients to be discharged earlier after ambulatory surgery. Outpatients are normally transferred from the OR to the PACU, followed by transfer to the Phase II step-down (day-surgery unit) before discharge home. ⋯ For these PACU fast-track patients, less monitoring is performed, a family member is permitted to be with the patient, and the patient is allowed to ambulate, change into street clothes, and be discharged home directly from the PACU without any time restrictions. Preliminary studies have shown that outpatients who are fast-tracked can be discharged home earlier without any increase in complications or side effects. Importantly, fast-tracking after ambulatory surgery does not seem to compromise patient satisfaction with the surgical experience.