Outpatient surgery

Since local anesthetics are capable of blocking all nerves, their actions are not limited to the desired loss of sensation from sites of noxious (painful) stimuli. Although motor paralysis can be desirable during surgery, it may also limit the ability of the patient to cooperate (ie, push) during obstetric delivery or ambulate without assistance after outpatient surgery. 

Cartwright DP, Kvalsvik O, Cassuto J, Jansen JP, Wall C, Remy B, Knape JT, Noronha D, Upadhyaya BK. A randomized, blind comparison of remifentanil and alfentanil during anesthesia for outpatient surgery. Anesth Analg 1997 85(5) 1014-9. 

Hartmannsgruber MW, Halaszynski TM. Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient surgery. Anesthesiology 2001 95(3) 627-31. 

Ambulatory care, including outpatient surgery centers, rehabilitation centers, infusion centers, group practices, and specialty centers, such as birthing centers, endoscopic centers, and pain centers. 

CLINICAL USE Desflurane is widely used for outpatient surgery because of its fast onset and recovery kinetics. The drug irritates the airway of awake patients, provoking coughing, salivation, and bronchospasm. Anesthesia therefore usually is induced with an intravenous agent, with desflurane subsequently administered for maintenance of anesthesia with inhaled concentrations of... 

Melvin (Mel) Anoma is a 46-year-old man who noted a superficial, brownish-black, 5-mm nodule with irregular borders in the skin on his chest. He was scheduled for outpatient surgery, at which time a wide excision biopsy was performed. (In an excision biopsy, the complete mole is removed and biopsy performed). Examination of the nodule indicated histologic changes characteristic of a malignant melanoma reaching a thickness of only 0.7 mm from the skin surface (Stage I). 

Propofol Propofol produces anesthesia at a rate similar to that of the intravenous barbiturates, and recovery is more rapid. Propofol has antiemetic actions, and recovery is not delayed after prolonged infusion. The drug is commonly used as a component of balanced anesthesia and as an anesthetic in outpatient surgery. Propofol may cause marked hypotension during induction of anesthesia, primarily through decreased peripheral resistance. Total body clearance of propofol is greater than hepatic blood flow, suggesting that its elimination includes other mechanisms in addition to metabolism by liver enzymes. 

The client diagnosed with cancer is being prepared for surgery. Which information should the outpatient surgery nurse convey to the surgeon immediately ... 

Alvarado, C. J., Carayon, P, Schools, H. A., Patient Safety CUmate (PSC) in Outpatient Surgery Centers—Part Two, Proceedings of the Human Factors and Ergonomics Society, 2005, pp. 1464-1468. 

Setting. Gastroenterologists may work in private practice or hospital settings. They also may work in nursing homes or long-term care facilities, hospices, or outpatient surgery centers. 

Outpatient Surgery Surgery involving less complex procedures that is done within a hospital or freestanding facility. Patients remain in the feciUty for less than twenty-four hours, as opposed to inpatient surgery, when the patient is admitted to a hospital and stays more than a day. 

Sutton, Amy L. Surgery Sourcebook. 2d ed. Detroit, Mich. Omnigraphics, 2008. Basic consumer information about common inpatient and outpatient surgeries. 

Nilsson A, Nilsson L, Ustaal E, Sjoberg F. Alfentanil and patient-controlled propofol sedation - facilitate g)maecological outpatient surgery with increased risk of respiratory events. Acta Anaesthesiol Scand 2012 56 1123-9. 

Manchikanti L, Canella MG, Hohlbein LJ, Colliver JA. Assessment of effect of various modes of premedication on acid aspiration risk factors in outpatient surgery. Anesth Analg 1987 66 81-84. 

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