Anesthesiology clinics of North America
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Office-based anesthesia, like other specific forms of anesthesia practice, has many unique attributes. Better work hours and a closer working relationship with surgeons and patients can provide the forum for a considerable amount of professional resonance. Moreover, the itinerant nature of the practice, the limited resources, and the need to innovate on the spur of the moment can make for variety and excitement. ⋯ It is inappropriate to view each OBS client as a minihospital. Although this may seem a simpler business model, the business and legal issues can be far more complex than those found in more traditional locales. A meld between business-person and clinician is becoming more a rule than an exception, and efforts to maintain and promote professional sovereignty will help forge continued growth of this unique form of anesthesiology practice.
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Ambulatory surgery provides quality care that is cost-effective. The use of innovative surgical and anesthetic techniques will allow larger numbers of patients to take advantage of the benefits of undergoing an elective operation on an ambulatory basis. Anesthesiologists will be faced with more complex surgery, which will require careful selection and assessment of patients to ensure continuity of the excellent safety record of ambulatory anesthesia. ⋯ The occurrence of these minor adverse advents is now the major area of quality assessment and an area where improvement could be targeted. Fast tracking facilitates earlier discharge, but we must ensure this has benefit to the patient as speedy discharge may mask the true incidence of adverse minor symptoms. This can lead to patient dissatisfaction and a poor impression of ambulatory surgery.
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An increasing number of surgical procedures are now performed on an ambulatory basis. This article reviews these conditions and defines the appropriate preoperative evaluation and perioperative management. Our goal is to define those patients who would benefit in having care in an inpatient setting or those who require more intensive medical evaluation or preparation prior to outpatient surgery.
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The growing importance of ambulatory surgery during the past decade has led to the development of efficient anesthetic techniques in terms of quality and safety of anesthesia and recovery. In these challenging objectives, intravenous techniques have played an important role, as they provide safe, efficient, and cost-effective anesthesia in the ambulatory setting. Among the numerous intravenous drugs, propofol, with its fast and smooth onset of action, short duration of action, and low incidence of postoperative side effects appears to be the anesthetic of choice in this situation. The recent development of new techniques of administration (such as TCI, monitored anesthesia care, or patient-controlled sedation) and monitoring (such as the BIS and the availability of "hit and run" drugs such as remifentanil) will optimize intraoperative conditions and recovery, thus allowing faster home readiness in the ambulatory setting.
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Anesthesiol Clin North America · Jun 2003
ReviewManagement of postoperative nausea and vomiting in ambulatory surgery.
The management of PONV has improved significantly over the years but remains a frequent occurrence in postoperative patients. Evaluation of individual patient risk and the consideration for prophylactic antiemetic in high-risk populations should reduce these unpleasant symptoms and help direct appropriate clinical strategies. Treatment following failure of prophylactic antiemetic therapy requires knowledge of previously used antiemetics and the time of their administration.