Anesthesia for Day Case Surgery
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Questions and Answers

What is the definition of a surgical day case?

A patient who is admitted to hospital, operated upon, and discharged on the same day.

What is one of the advantages of day case surgery for the patient?

Less disruption and more pleasant for the patient and the family.

What should an outpatients surgical unit have in terms of equipment?

All anesthetic drugs, equipment, monitors, and emergency drugs.

What type of patients should be avoided for day case surgery due to age?

<p>Extremes of ages and premature babies.</p> Signup and view all the answers

What type of surgical procedures are suitable for day case surgery?

<p>Operations of short durations with less bleeding and fewer postoperative complications.</p> Signup and view all the answers

Why should infected cases be avoided for day case surgery?

<p>To reduce the risk of postoperative complications and hospital-acquired infections.</p> Signup and view all the answers

Why should patients with risk of airway obstruction be avoided for day case surgery?

<p>To minimize the risk of postoperative respiratory complications.</p> Signup and view all the answers

What provision should be made in an outpatients surgical unit in case of adverse situations?

<p>Facility for hospital admission.</p> Signup and view all the answers

What type of muscle relaxants are used for intubation?

<p>Suxamethonium</p> Signup and view all the answers

What are the advantages of general anesthesia?

<p>Immediate speedy effect, patient comfort, and generalized effect</p> Signup and view all the answers

What is a potential complication of general anesthesia?

<p>Loss of protective airway reflexes, risk of vomiting and aspiration</p> Signup and view all the answers

What is a crucial aspect of postoperative care?

<p>Full recovery and patient wakefulness</p> Signup and view all the answers

What are the criteria for discharge after anesthesia?

<p>Maintaining patent airway, complete recovery, stable vital signs, and others</p> Signup and view all the answers

Why is it essential to provide instructions and advice at the time of discharge?

<p>To inform patients about activity, medication, and complications</p> Signup and view all the answers

In what circumstances may a patient need hospital admission after anesthesia?

<p>Persistent nausea, aspiration pneumonitis, and poorly controlled coexisting medical diseases</p> Signup and view all the answers

How long do patients typically need to wait before being discharged after anesthesia?

<p>3-4 hours</p> Signup and view all the answers

What is the importance of pre-anesthetic visit in the preoperative evaluation?

<p>It is important for history and examination, medical and anesthetic history, necessary laboratory tests, and written consent of operation and anesthesia.</p> Signup and view all the answers

What are the necessary laboratory tests required for preoperative evaluation?

<p>Routine blood exam (CBC), urine exam, chest X-ray, ECG, and blood biochemistry (sugar, urea, creatinine) for aged patients.</p> Signup and view all the answers

What is the purpose of premedication in preanesthetic preparation?

<p>To reduce anxiety and prevent aspiration of gastric contents.</p> Signup and view all the answers

When may postponement of surgery be indicated?

<p>No written consent, no responsible escort available, late attending in clinic, full stomach, or change of medical conditions.</p> Signup and view all the answers

What factors influence the choice of anesthesia?

<p>Patient want, surgical requirement, time of surgical procedure, age of the patient, physical condition of the patient, duration of drug action, and requirement of post anesthetic nursing.</p> Signup and view all the answers

What are the advantages of regional anesthesia?

<p>Anesthesia of the surgical site, patient awareness, less physiological disturbance, and good condition of patient at the time of discharge.</p> Signup and view all the answers

What are the inducing agents used in general anesthesia?

<p>Thiopentone, ketamine, and propofol.</p> Signup and view all the answers

What are the types of regional anesthesia?

<p>Local anesthesia, spinal block, and epidural block.</p> Signup and view all the answers

Study Notes

Anesthesia for Day Case Surgery

  • A surgical day case is a patient who is admitted to the hospital, operated on, and discharged on the same day.
  • Day case surgery has advantages for the patient, including less disruption, earlier return to work or school, reduced waiting time, lower risk of hospital-acquired infections, and decreased postoperative respiratory complications.

Outpatient Surgical Unit

  • The unit should have an adequate place with an operating theater, preoperative check, and post-anesthetic recovery rooms.
  • The recovery room should be large enough to accommodate all cases for several hours.
  • All anesthetic drugs, equipment, monitors, emergency drugs, and sufficient staff should be available.
  • The unit should have a facility for hospital admission in case of adverse situations.

Patient Selection

  • Patient selection criteria include:
    • ASA physical status 1, 2, and 3 (controlled)
    • Patients and accompanying persons must follow directions and advice
    • A capable person must help the patient at home
    • Extremes of ages and premature babies should be avoided
    • Morbid obesity, physical and mental handicaps should be avoided
  • Surgery-related criteria include:
    • Operations of short durations
    • Surgery with less bleeding and postoperative complications
    • Avoiding patients with risk of airway obstruction
    • Infected cases should be avoided
    • Emergency cases are not suitable
    • Operations with severe postoperative pain may be avoided

Preoperative Evaluation

  • Pre-anesthetic visit is important
  • History and examination should be done
  • Medical and anesthetic history are important
  • Laboratory tests should be done, including:
    • Routine blood exam (CBC)
    • Urine exam
    • Chest X-ray
    • ECG (as needed)
    • Blood biochemistry (sugar, urea, creatinine) for aged patients
  • Written consent of operation and anesthesia is necessary

Preanesthetic Preparation

  • Nothing by mouth (fasting) prior to anesthesia
  • H2 receptor antagonists, antacids, metoclopramide may be given
  • Premedication (diazepam and atropine sulphate) may be given
  • Laboratory tests should be accurate and confirmed
  • Physical condition should be reassessed and evaluated
  • Patient should present at scheduled time
  • Patient should wear operating theatre dresses
  • No cosmetics, jewelry, or contact lens

Postponement of Surgery

  • May be indicated due to:
    • No written consent
    • No responsible escort available
    • Late attending in clinic
    • Full stomach
    • Change of medical conditions

Anesthesia

  • Choice of anesthesia depends on:
    • Patient's desire
    • Surgical requirement
    • Time of surgical procedure
    • Age of the patient
    • Physical condition of the patient
    • Duration of drug action
    • Requirement of post-anesthetic nursing
    • Judgment of the anesthetist concerned

Regional Anesthesia

  • Includes local anesthesia, spinal block, or epidural block
  • Advantages:
    • Anesthesia of the surgical site
    • Patient awareness
    • Less physiological disturbance
    • Good condition of the patient at the time of discharge
  • Disadvantages:
    • Needs time
    • Failure or incomplete block can occur
    • Specific complications for block

General Anesthesia

  • Advantages:
    • Smooth induction, easy maintenance, early recovery
    • Halothane, isoflurane, sevoflurane can be used
    • IV agents such as thiopentone and ketamine can be used as inducing agents
    • Propofol can induce and maintain anesthesia
    • Midazolam or fentanyl can be used
    • Muscle relaxants can be used for intubation
  • Disadvantages:
    • Loss of protective airway reflexes
    • Risk of vomiting, aspiration
    • Cardiovascular depression

Postoperative Care

  • Patient should be fully awake (recovery)
  • Monitor vital signs
  • Complications can occur, such as pain, nausea, vomiting, delayed recovery, and hypotension

Criteria for Discharge

  • Patient should:
    • Maintain a patent airway, with no respiratory depression or airway obstruction
    • Have complete recovery, with stable vital signs
    • Be oriented to person, place, and time
    • Not be drowsy, with clear vision
    • Not have fever or hypothermia
    • Be able to sit and walk without help
    • Be able to eat and drink and pass urine
    • Not have severe pain, vomiting, dehydration, or postoperative bleeding
    • Have a responsible adult person present to accompany the patient
    • Most patients are fit enough to go home after about 3-4 hours

Instructions and Advices at the Time of Discharge

  • Regarding activity, medication, dressing, diet, and bathing
  • Patients should know what to do and where to contact if complications arise
  • Patients should not drive cars or do complex jobs
  • Instructions should be written and given to the patient and escort

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Description

This quiz covers the basics of anesthesia for day case surgery, including the definition and purposes of day case patients. It's part of the 2nd semester anesthesia theory lecture.

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