The Urologic clinics of North America
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Most urologic procedures can be performed under regional blockade anesthesia. These techniques present specific advantages, including the avoidance of the consequences of general anesthesia. The employment of regional anesthesia is a skill requiring knowledge of anatomy and of the desirable and undesirable actions of local anesthetic agents. Sedation of patients undergoing regional blockade offers specific advantages that may contribute to the patient's comfort and safety.
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Because of the developments in urologic instruments and procedures and the new medications used in intravenously assisted local anesthesia, most urologic operations and procedures can be performed in an appropriate office surgical suite. In-office surgery costs are lower, physician time is optimized, patients are happier, and excellent quality care can be assured. Accreditation by the Accreditation Association for Ambulatory Health Care and Medicare licensure both make facility fee reimbursement adequate for maintenance of a high-quality surgical facility.
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Successful anesthetic management of children undergoing outpatient surgery requires that the surgeon and anesthesiologist be actively involved in all aspects of management. Guidelines should be established in consultation with the surgeons, nurses, and administrators to ensure proper selection and preoperative preparation of patients. The psychological evaluation and preparation of children, and the use of pharmacologic premedication when indicated, will ensure a pleasant experience for all involved. ⋯ Special attention must be paid to the analgesic requirements of the child. Regional blocks should be used whenever possible to supplement "light" general anesthesia and to limit the need for narcotics during recovery. Specific criteria for discharge ensure the safety and protection of the child and staff.
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By the year 1990, it is projected that 50 per cent of all surgery in the United States will be performed on an outpatient basis. Both surgeons and anesthesiologists must understand patient and procedure prerequisites for outpatient surgery. ⋯ Patients must meet established clinical criteria prior to discharge and must be examined by a physician at the time these criteria have been met. The physician's clinical judgment is the single most important factor in determining the patient's home readiness.