Additional Information
Book Details
Abstract
Ambulatory anesthesia is used for surgical procedures where the patient does not need to stay overnight in the hospital. The same anesthetics that are used in the operating room setting are used in the ambulatory setting, including general, regional and local anesthetics. Sedation anesthetics are also given in the ambulatory setting. This issue will cover best practices and procedures for perioperative care, regional anesthesia, pediatric anesthesia, administering office anesthesia, and more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Ambulatory\rAnesthesiology | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Anesthesiology Clinics\r | xiii | ||
| Foreword\r | xv | ||
| Preface\r | xvii | ||
| Perioperative Management of Co-Morbidities | A1 | ||
| Perioperative Evaluation and Management of Cardiac Disease in the Ambulatory Surgery Setting | 309 | ||
| Key points | 309 | ||
| Introduction | 309 | ||
| Hypertension | 310 | ||
| Functional capacity | 310 | ||
| Coronary artery disease | 310 | ||
| Heart failure | 311 | ||
| Coronary stents | 312 | ||
| Cardiovascular implantable electronic devices: pacemakers and implantable cardioverter defibrillators | 312 | ||
| Aortic stenosis | 313 | ||
| Prosthetic heart valves | 314 | ||
| Preoperative testing | 315 | ||
| Perioperative medical management | 315 | ||
| Prophylaxis for infective endocarditis | 315 | ||
| Putting it all together: a stepwise practical approach for ambulatory surgery | 316 | ||
| Preoperative cardiac evaluation on the horizon | 318 | ||
| References | 318 | ||
| Perioperative Consideration of Obstructive Sleep Apnea in Ambulatory Surgery | 321 | ||
| Key points | 321 | ||
| Introduction | 321 | ||
| Risk factors and pathophysiology | 322 | ||
| Diagnostic criteria of OSA | 322 | ||
| Methods for perioperative screening for OSA | 322 | ||
| Preoperative evaluation of the patient with suspected or diagnosed OSA for ambulatory surgery | 322 | ||
| Outcome of patients with OSA undergoing ambulatory surgery | 324 | ||
| Perioperative care of patients with OSA for ambulatory surgery | 324 | ||
| Postoperative disposition and unplanned admission after ambulatory surgery | 325 | ||
| Summary | 326 | ||
| References | 326 | ||
| Management of Diabetes Medications for Patients Undergoing Ambulatory Surgery | 329 | ||
| Key points | 329 | ||
| Preoperative inquiries | 329 | ||
| Medications for Type 2 Diabetes Mellitus | 329 | ||
| Insulin | 330 | ||
| Insulin Pumps | 330 | ||
| Hypoglycemia | 330 | ||
| Significance of diabetes in surgical outpatients | 332 | ||
| Glycemic Disturbances | 332 | ||
| Evidence for Glucose Control in Critical Care and Surgical Patients | 332 | ||
| Perioperative management of diabetes medications | 332 | ||
| Insulin Dosing | 332 | ||
| Day prior to surgery | 332 | ||
| Day of surgery | 334 | ||
| Correction doses of insulin | 335 | ||
| Insulin pumps | 335 | ||
| Oral Medications | 335 | ||
| Anesthesia care | 336 | ||
| Scheduling | 336 | ||
| Glucose Measurement | 337 | ||
| Abnormal Blood Glucose Values | 337 | ||
| Postoperative Care | 337 | ||
| References | 337 | ||
| Regional Anesthesia | A3 | ||
| Peripheral Nerve Blocks for Ambulatory Surgery | 341 | ||
| Key points | 341 | ||
| Introduction | 341 | ||
| Upper extremity PNBs | 344 | ||
| Interscalene Block | 344 | ||
| Supraclavicular Block | 346 | ||
| Infraclavicular Block | 346 | ||
| Axillary Block | 348 | ||
| Lower extremity PNBs | 348 | ||
| Femoral Nerve Block | 349 | ||
| Sciatic Nerve Block | 349 | ||
| Summary | 350 | ||
| References | 350 | ||
| Neuraxial Anesthesia for Outpatients | 357 | ||
| Key points | 357 | ||
| Introduction | 357 | ||
| Selection of agents | 357 | ||
| Epidural anesthesia | 360 | ||
| Selection of agents | 364 | ||
| Side effects | 365 | ||
| Summary | 368 | ||
| References | 368 | ||
| Anesthesia for Procedures | A5 | ||
| Anesthesia for Ambulatory Diagnostic and Therapeutic Radiology Procedures | 371 | ||
| Key points | 371 | ||
| Introduction | 371 | ||
| Contrast | 372 | ||
| Other contrast media | 372 | ||
| MRI | 372 | ||
| Magnet Safety | 372 | ||
| Anesthetic Considerations for MRI | 372 | ||
| Monitoring/patient access | 374 | ||
| Ear safety | 375 | ||
| Interventional radiology | 375 | ||
| Radiation Safety | 375 | ||
| Anesthetic considerations for interventional radiology | 376 | ||
| Anesthetic | 376 | ||
| Monitoring/Equipment | 377 | ||
| Procedures | 377 | ||
| Postprocedure care | 379 | ||
| Summary | 379 | ||
| References | 379 | ||
| Ambulatory Anesthesia for the Cardiac Catheterization and Electrophysiology Laboratories | 381 | ||
| Key points | 381 | ||
| Introduction | 381 | ||
| Consultation: a multidisciplinary approach | 381 | ||
| General strategies for the ambulatory anesthesiologist | 382 | ||
| Higher risk procedures in the ambulatory surgery setting | 382 | ||
| Complex Catheter Ablation | 382 | ||
| Lead Extractions for Cardiovascular Implantable Electronic Devices | 383 | ||
| Transcatheter aortic valve replacement | 384 | ||
| Radiation safety | 384 | ||
| Summary | 385 | ||
| References | 385 | ||
| Nonoperating Room Anesthesia for the Gastrointestinal Endoscopy Suite | 387 | ||
| Key points | 387 | ||
| The patients | 388 | ||
| The procedures | 388 | ||
| Anesthesia techniques for GI endoscopy | 389 | ||
| Preanesthesia preparation for the GI endoscopy suite | 390 | ||
| Anesthetic technique | 390 | ||
| Postanesthesia care | 392 | ||
| An increasing role for anesthesia in the GI endoscopy suite of the future | 392 | ||
| References | 393 | ||
| Chronic Pain | 395 | ||
| Key points | 395 | ||
| Introduction | 395 | ||
| History of interventional pain management | 395 | ||
| Anesthesia techniques in off-site locations | 396 | ||
| Interventional pain-relieving procedures | 396 | ||
| Complications related to anesthetic techniques in interventional pain procedures | 402 | ||
| Airway Compromise | 402 | ||
| Disinhibition and Agitation | 402 | ||
| Predisposition to Neural Injury | 403 | ||
| Summary | 407 | ||
| References | 407 | ||
| Pediatric Ambulatory Anesthesia | 411 | ||
| Key points | 411 | ||
| Introduction | 411 | ||
| Patient selection | 412 | ||
| Upper Respiratory Infection | 412 | ||
| Apnea Risk in Infants | 413 | ||
| Sleep Apnea and Tonsillectomy | 414 | ||
| Cardiac Risk | 414 | ||
| Undiagnosed Weakness or Hypotonia | 415 | ||
| MH | 415 | ||
| Hyperkalemic cardiac arrest | 415 | ||
| PRIS | 416 | ||
| Preoperative Pregnancy Testing | 416 | ||
| Preoperative management | 416 | ||
| Nonpharmacological Anxiolysis | 416 | ||
| Clowns and magicians | 416 | ||
| Audiovisual material and games | 418 | ||
| Humor and verbal methods | 418 | ||
| Intraoperative management | 418 | ||
| Intubation Without Neuromuscular Blockade: Remifentanil | 418 | ||
| Pain Management for Circumcision | 420 | ||
| Acetaminophen: Rectal Dosing | 420 | ||
| Summary | 422 | ||
| References | 422 | ||
| Initial Results from the National Anesthesia Clinical Outcomes Registry and Overview of Office-Based Anesthesia | 431 | ||
| Key points | 431 | ||
| Introduction | 431 | ||
| Administrative and safety issues | 432 | ||
| Literature Review | 432 | ||
| Accreditation and Other Administrative Issues | 434 | ||
| Facility, Patient, and Procedure Selection | 435 | ||
| Data analysis from the Anesthesia Quality Institute | 437 | ||
| Future direction of OBA | 442 | ||
| References | 442 | ||
| Airway Management | 445 | ||
| Key points | 445 | ||
| Introduction | 445 | ||
| Lessons learned from recent studies | 446 | ||
| The Fourth National Audit Project of the United Kingdom | 446 | ||
| 2013 Update: ASA Difficult Airway Algorithm | 448 | ||
| The SGA: When Might It Fail? | 449 | ||
| Videolaryngoscopes: Glottic View Versus Successful Intubation | 449 | ||
| Airway assessment | 453 | ||
| Developing an Airway Strategy | 454 | ||
| SGA Tips for Success | 455 | ||
| VL: Tips for Success | 456 | ||
| Anesthetic emergence and extubation | 456 | ||
| The Bailey Maneuver | 456 | ||
| Emergency equipment | 458 | ||
| Summary | 460 | ||
| References | 460 | ||
| New Medications and Techniques in Ambulatory Anesthesia | 463 | ||
| Key points | 463 | ||
| Introduction | 463 | ||
| Novel sedative-hypnotics drugs and delivery systems | 464 | ||
| Propofol Formulations | 464 | ||
| Alternate Propofol Emulsion Formulations | 464 | ||
| Ampofol | 464 | ||
| IDD-D Propofol 2% | 464 | ||
| AM149 | 465 | ||
| Propofol-Lipuro 1% and 2% | 465 | ||
| Albumin emulsions | 466 | ||
| Nonemulsion Formulations | 466 | ||
| Propofol cyclodextrin formulation | 466 | ||
| Micelle formulations | 467 | ||
| Propofol Prodrugs (Fospropofol, HX0969w) | 467 | ||
| SEDASYS System | 468 | ||
| Benzodiazepine Receptor Agonists | 469 | ||
| PF0713 | 469 | ||
| Remimazolam (CNS 7056) | 469 | ||
| AZD 3043 (previously named TD-4756) | 469 | ||
| JM-1232 (-) (MR04A3) | 470 | ||
| Etomidate Derivatives | 470 | ||
| Methoxycarbonyl etomidate | 471 | ||
| Cyclopropyl MOC etomidate | 471 | ||
| MOC-carboetomidate | 472 | ||
| Other Class | 472 | ||
| Melatonin | 472 | ||
| Novel neuromuscular blocking/reversal agents | 472 | ||
| Gantacurium (GW280430A) | 473 | ||
| CW 002 | 473 | ||
| Sugammadex | 473 | ||
| Novel analgesics and analgesic delivery systems | 473 | ||
| Kappa-Opioid Agonists | 474 | ||
| CR665 (JNJ-38488502) | 475 | ||
| CR845 | 475 | ||
| Local Anesthetics | 476 | ||
| EXPAREL (bupivacaine liposome injectable suspension 1.3%) | 476 | ||
| SABER-Bupivacaine | 478 | ||
| Nonintravenous formulations of fentanyl | 478 | ||
| Summary | 479 | ||
| References | 479 | ||
| Postop Issues/Care/Discharge | A7 | ||
| Postoperative Issues | 487 | ||
| Key points | 487 | ||
| Postanesthetic recovery | 487 | ||
| Discharge scoring system | 488 | ||
| Fast-Tracking | 488 | ||
| Discharge from Ambulatory Surgical Unit | 489 | ||
| Discharge After Regional Anesthesia | 489 | ||
| Postdischarge Instructions | 491 | ||
| Summary | 492 | ||
| References | 492 | ||
| Acute Pain Management | 495 | ||
| Key points | 495 | ||
| Introduction | 495 | ||
| Identify: risk stratification, preprocedural planning | 497 | ||
| Implement: MMA, regional anesthesia | 497 | ||
| Implement: MMA, pharmacotherapy | 499 | ||
| Implement: nonpharmacologic techniques | 500 | ||
| Intervene: recovery room rescue | 500 | ||
| Summary | 500 | ||
| References | 501 | ||
| Long-Acting Serotonin Antagonist (Palonosetron) and the NK-1 Receptor Antagonists | 505 | ||
| Key points | 505 | ||
| Introduction | 505 | ||
| Risk factor identification | 506 | ||
| Pharmacologic intervention | 506 | ||
| Palonesetron | 508 | ||
| Aprepritant, Casopitant, Rolapitant | 508 | ||
| Clinical evidence of efficacies | 509 | ||
| Palonosetron | 509 | ||
| Neurokinin Receptor Antagonist | 511 | ||
| Summary | 513 | ||
| References | 513 | ||
| Administrative Issues | A9 | ||
| Scheduling of Procedures and Staff in an Ambulatory Surgery Center | 517 | ||
| Key points | 517 | ||
| Introduction | 517 | ||
| Basic definitions | 518 | ||
| Systems for procedure scheduling | 518 | ||
| Using utilization to assign or time | 522 | ||
| Prediction of procedure duration | 522 | ||
| Categories of OR delays | 524 | ||
| Summary | 526 | ||
| References | 526 | ||
| Practice Management/Role of the Medical Director | 529 | ||
| Key points | 529 | ||
| Introduction | 529 | ||
| History and development of the ambulatory surgery medical director | 530 | ||
| Management by outcomes and process improvement | 531 | ||
| Care pathway development: reducing error and improving quality by reducing variation | 536 | ||
| Summary | 536 | ||
| References | 538 | ||
| Appendix 1 Example of a multidisciplinary algorithm of care resulting from a safety event | 538 | ||
| Surgical Team | 538 | ||
| Anesthesia Team | 539 | ||
| Pre-operative/Recovery Nurse | 540 | ||
| Legal Aspects of Ambulatory Anesthesia | 541 | ||
| Key points | 541 | ||
| Practice-related legal issues | 541 | ||
| Professional Liability | 541 | ||
| Patient selection | 542 | ||
| Informed consent | 542 | ||
| Professional association standards | 543 | ||
| Regulatory Considerations | 543 | ||
| CMS conditions for coverage | 543 | ||
| State law requirements | 544 | ||
| Kickbacks | 544 | ||
| Stark and physician self-referrals | 545 | ||
| Contracts | 546 | ||
| Ownership-related legal issues | 546 | ||
| Federal Antikickback Statute Restrictions on Ownership | 546 | ||
| Stark Law Considerations | 547 | ||
| State Law Requirements | 548 | ||
| Requirements that referring physicians perform the services themselves | 548 | ||
| Disclosure or sunshine requirements | 548 | ||
| Summary | 548 | ||
| References | 548 | ||
| Accreditation of Ambulatory Facilities | 551 | ||
| Key points | 551 | ||
| Introduction | 551 | ||
| Accrediting organizations | 552 | ||
| Deemed status | 553 | ||
| Ambulatory facility regulation by states | 554 | ||
| Quality reporting and outcomes | 555 | ||
| References | 556 | ||
| Anesthesia Information Management Systems in the Ambulatory Setting | 559 | ||
| Key points | 559 | ||
| Benefits | 560 | ||
| Medical Record Review | 560 | ||
| Support Links (Information Buttons) | 561 | ||
| Organization of Information | 561 | ||
| Automatic Transfer of Vital Signs | 561 | ||
| Legibility | 562 | ||
| AIMS is Integrated with the EHR | 563 | ||
| Decision Support | 563 | ||
| Menus | 564 | ||
| Compliance | 565 | ||
| Icons Communicate Patient Status | 566 | ||
| Registries | 567 | ||
| Summary of benefits | 568 | ||
| Challenges | 569 | ||
| Report Management | 569 | ||
| Forest-for-the-trees Dilemma | 569 | ||
| Garbage In, Garbage Out | 569 | ||
| Short Cases Require an Experienced AIMS User | 569 | ||
| Device Integration | 569 | ||
| Support and Downtimes | 570 | ||
| Alerts After the Fact | 570 | ||
| Workstation Reliability and Availability | 571 | ||
| Cost | 571 | ||
| Medicolegal Concerns | 573 | ||
| The future | 574 | ||
| Standardization | 574 | ||
| Access and Portability in a Health Information Exchange | 574 | ||
| Wireless Monitoring and Integration | 574 | ||
| Mobile Technology | 574 | ||
| Summary | 575 | ||
| References | 575 | ||
| Quality Management and Registries | 577 | ||
| Key points | 577 | ||
| Why quality management is important and how to do it | 577 | ||
| External resources and registries | 580 | ||
| What data to collect | 582 | ||
| How to use QM data | 583 | ||
| Summary | 585 | ||
| References | 585 | ||
| Index | 587 |