This document provides guidelines for pediatric ambulatory surgery. It discusses patient selection and preparation, including preoperative screening and common medical conditions. It also covers anesthesia techniques and agents, focusing on general versus regional anesthesia and new versus old inhalation agents. Finally, it addresses management of side effects like nausea and vomiting as well as postoperative analgesia.
1. The document discusses perioperative mortality and safe anesthesia practices. It defines anesthetic death and classifies the causes of perioperative mortality.
2. Major causes of perioperative mortality include human error, communication failures, equipment failures, and underlying patient diseases. The document provides strategies to prevent complications through improved preoperative assessment, monitoring standards, anesthesia techniques, and postoperative care.
3. In the event of a complication or death, the document stresses the importance of general management practices like monitoring, diagnosis, and treatment, as well as thorough documentation, handling of deceased patients sensitively, and communicating with family members.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
Anesthesiologists must ensure patient safety during operations as anesthesia carries risks. Factors threatening safety include equipment issues, patient health conditions, and human factors like fatigue. Strategies to improve safety include thorough preoperative evaluations and planning, situational awareness during procedures, cross-checking observations, preparing for emergencies, enhancing teamwork, and learning from adverse events. Common errors involve airway issues, medication errors, and procedure mistakes, which can be avoided through vigilance, training, and following standards and guidelines. Quality assurance aims to improve care and minimize risks through documentation, safety training, and protocols for monitoring, handoffs, and responding to adverse events.
This document provides an overview of the history and definitions of ambulatory surgery. Key points include:
- Ambulatory surgery is defined as surgery where the patient is discharged on the same working day, in contrast to inpatient surgery where patients stay overnight.
- Ambulatory surgery became common in the 1970s-1980s in developed countries, where now 50-70% of surgeries are done on an ambulatory basis.
- Ambulatory surgery provides benefits in terms of safety, quality, economics, and staff satisfaction compared to traditional inpatient surgery models. When proper standards of care are followed, ambulatory surgery has been shown to be as safe as inpatient surgery.
The document discusses ambulatory or day surgery. It defines day surgery as when a patient is admitted for a procedure and discharged within 12 hours. Day surgery has advantages over traditional inpatient surgery like lower costs, faster recovery, and less disruption to daily life. The document outlines patient selection criteria, common procedures performed as day surgery, and important considerations for the preoperative, intraoperative, and postoperative periods to facilitate day surgery and recovery.
1. This document provides guidelines for day case and short stay surgery from a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.
2. Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.
3. Selection of patients for day surgery considers social factors like having a caregiver at home, medical factors like fitness and stability of chronic conditions, and surgical factors like risk of complications requiring immediate medical attention.
The document discusses preoperative, intraoperative, and postoperative care for a patient undergoing surgery. In the preoperative stage, patients undergo assessments of their medical history and comorbidities, labs and tests are ordered to optimize the patient's health status, and the surgical plan is arranged. Intraoperatively, strict infection control protocols are followed and checklists are used to ensure safety. Postoperatively, patients are monitored, complications are prevented, and care is documented before discharge. The overall goal is to safely prepare the patient for surgery, perform the procedure, and provide care during recovery.
Importanza anestesista in oftalmologia 2013;role of the anesthesiologists in ...Claudio Melloni
Role of the anesthesiologist in ophthalmic surgery;cases,monitoring, challenges,screening of patients,complications,discussion from literature and more .dangers of Phenylephrine,accidents.
Heavy file,with documents not properly pictured,but useful for discussion.
1. The document discusses perioperative mortality and safe anesthesia practices. It defines anesthetic death and classifies the causes of perioperative mortality.
2. Major causes of perioperative mortality include human error, communication failures, equipment failures, and underlying patient diseases. The document provides strategies to prevent complications through improved preoperative assessment, monitoring standards, anesthesia techniques, and postoperative care.
3. In the event of a complication or death, the document stresses the importance of general management practices like monitoring, diagnosis, and treatment, as well as thorough documentation, handling of deceased patients sensitively, and communicating with family members.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
Anesthesiologists must ensure patient safety during operations as anesthesia carries risks. Factors threatening safety include equipment issues, patient health conditions, and human factors like fatigue. Strategies to improve safety include thorough preoperative evaluations and planning, situational awareness during procedures, cross-checking observations, preparing for emergencies, enhancing teamwork, and learning from adverse events. Common errors involve airway issues, medication errors, and procedure mistakes, which can be avoided through vigilance, training, and following standards and guidelines. Quality assurance aims to improve care and minimize risks through documentation, safety training, and protocols for monitoring, handoffs, and responding to adverse events.
This document provides an overview of the history and definitions of ambulatory surgery. Key points include:
- Ambulatory surgery is defined as surgery where the patient is discharged on the same working day, in contrast to inpatient surgery where patients stay overnight.
- Ambulatory surgery became common in the 1970s-1980s in developed countries, where now 50-70% of surgeries are done on an ambulatory basis.
- Ambulatory surgery provides benefits in terms of safety, quality, economics, and staff satisfaction compared to traditional inpatient surgery models. When proper standards of care are followed, ambulatory surgery has been shown to be as safe as inpatient surgery.
The document discusses ambulatory or day surgery. It defines day surgery as when a patient is admitted for a procedure and discharged within 12 hours. Day surgery has advantages over traditional inpatient surgery like lower costs, faster recovery, and less disruption to daily life. The document outlines patient selection criteria, common procedures performed as day surgery, and important considerations for the preoperative, intraoperative, and postoperative periods to facilitate day surgery and recovery.
1. This document provides guidelines for day case and short stay surgery from a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.
2. Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.
3. Selection of patients for day surgery considers social factors like having a caregiver at home, medical factors like fitness and stability of chronic conditions, and surgical factors like risk of complications requiring immediate medical attention.
The document discusses preoperative, intraoperative, and postoperative care for a patient undergoing surgery. In the preoperative stage, patients undergo assessments of their medical history and comorbidities, labs and tests are ordered to optimize the patient's health status, and the surgical plan is arranged. Intraoperatively, strict infection control protocols are followed and checklists are used to ensure safety. Postoperatively, patients are monitored, complications are prevented, and care is documented before discharge. The overall goal is to safely prepare the patient for surgery, perform the procedure, and provide care during recovery.
Importanza anestesista in oftalmologia 2013;role of the anesthesiologists in ...Claudio Melloni
Role of the anesthesiologist in ophthalmic surgery;cases,monitoring, challenges,screening of patients,complications,discussion from literature and more .dangers of Phenylephrine,accidents.
Heavy file,with documents not properly pictured,but useful for discussion.
The document discusses the care of surgical patients from pre-operation through recovery. It covers preparing the patient physically and psychologically for surgery, different types of surgeries and anesthesia, and the roles and responsibilities of staff in caring for surgical patients before, during, and after a procedure. Common patient fears are also addressed.
This document discusses ambulatory and fast track anesthesia. It covers topics such as the benefits of ambulatory surgery including lower costs and greater efficiency. It describes different facility designs for ambulatory surgery and lists many common procedures that can be done on an outpatient basis. The document outlines considerations for patient selection and preoperative preparation including pharmacologic and non-pharmacologic techniques. It also discusses various anesthetic techniques for ambulatory surgery like general anesthesia, regional anesthesia, and monitored anesthesia care. Fast tracking approaches to minimize side effects like PONV are also summarized.
Surgeon Champion Call 2010 - Dr Peter Dorismart1971
This document summarizes the journey of Surrey Memorial Hospital in implementing the ACS-NSQIP program to track surgical outcomes and improve quality. It describes initial challenges with data quality including missing data, coding errors and inconsistencies that were addressed through staff education and updated processes. It provides examples of pneumonia and catheter-associated urinary tract infection prevention initiatives that were undertaken using a team-based approach including practice changes, education and audits to reduce infection rates. Graphics show outcomes data over time comparing the hospital to NSQIP benchmarks.
This document summarizes a policy brief on increasing day surgery (ambulatory surgery where patients are discharged the same day). It discusses the history and growth of day surgery as a cost-effective alternative to inpatient surgery. While day surgery accounts for nearly 90% of surgeries in some countries, rates vary widely between countries and hospitals. The brief examines how expanding day surgery could benefit healthcare systems by increasing throughput, reducing costs and wait times. However, barriers still exist in some countries that prevent day surgery from reaching its full potential. Overcoming these barriers may require changes to policies, regulations, healthcare facilities and staffing.
Anesthesia carries risks that can lead to patient death or injury. Several factors contribute to risks in the operating room including equipment issues, patient health factors, human performance errors, and system failures. Some key errors that can cause severe harm are airway issues, medication errors, and procedure mistakes. Maintaining vigilance, checklists, standards, training, and learning from adverse events can help improve safety. Thorough documentation and review of incidents is important for quality assurance.
Structured Approach to Critically Ill and Injured Patientmetriccertain
CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and iNjury) is designed and developed to standardize the approach to the evaluation and treatment of acutely decompensating patients. The design and content was informed by the survey of clinicians from diverse international settings. Available in electronic (laptop/mobile) and paper formats, CERTAIN provides evidence based diagnostic checklists, clinical decision support, educational modules on performing critical procedures, and has the ability to time and document real-time interventions. CERTAIN prompting has been shown to improve performance of clinical providers faced with simulated emergencies.
This document discusses safe anesthesia practice and crisis management during anesthesia. It begins by defining safety for the anesthetist, surgeon, and patient. It then outlines international standards for safe anesthesia practice from 2010, including pre-anesthesia checks, monitoring during anesthesia, and crisis management protocols. Specific techniques are also discussed, such as managing a difficult airway and addressing laryngospasm. The presentation emphasizes protocols, checklists, skills, teamwork and communication to ensure patient safety.
This document discusses strategies to improve patient safety during anesthesia. It identifies that anesthesia can induce physiological changes that increase morbidity and mortality risks, so factors threatening safety in the operating room must be addressed. These factors include equipment issues, patient health problems, and human errors by anesthetists and surgeons. The document recommends developing preoperative plans, maintaining situational awareness during procedures, emphasizing teamwork and communication, avoiding production pressures, and fostering a learning culture where errors are reported and used to implement safety improvements.
Dental Implant 1 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Perioperative evaluation and management of surgicalFateme Roodsarabi
This document provides guidance on preoperative evaluation and management of patients undergoing elective surgery. It recommends focusing the evaluation on the patient's medical history and physical exam rather than routine screening tests. It provides criteria for when basic lab tests or specialist consultations are warranted based on a patient's health conditions and type of surgery. Guidance is given for the preoperative management of common patient populations like those with cardiac, pulmonary, renal or liver disease, diabetes, or who are pregnant/elderly.
The document discusses improving safety standards for office-based surgery and anesthesia. It notes a lack of uniform regulation has led to increasing complexity of cases performed in office settings. It introduces the Institute for Safety in Office Based Surgery, a non-profit established in 2009 to promote patient safety, develop tools for risk detection, and encourage physician education and evidence-based standards of care. It also references the high-profile case of Joan Rivers' death from complications during an outpatient procedure.
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and have minimal postoperative physiological disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and shorter-acting drugs that allow for faster recovery.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
This document discusses ambulatory anesthesia and day-care surgery. It provides a brief history of ambulatory anesthesia, noting key developments from 1903 to present day. It describes the objectives and techniques of anesthesia for day-care surgery, including premedication, induction agents, maintenance techniques, regional versus general anesthesia, advantages and disadvantages, selection criteria for patients, and discharge criteria. The success of day-care surgery depends on appropriate patient selection, facility availability, and type of surgical procedure.
This document provides biographical information about the editors of the book "Anesthesia in Day Care Surgery". M.M. Begani has over 40 years of experience as a surgeon in Mumbai, India. He helped pioneer the use of local anesthesia for day surgeries. Dheeraj V. Mulchandani is a consultant surgeon in Mumbai with extensive experience in general and laparoscopic surgery. Shagufta Choudhary is a consultant anesthesiologist who has dedicated her career to advancing ambulatory anesthesia and minimizing hospitalization time for day surgeries. The introduction emphasizes how this handbook aims to enable day surgeries across many specialties using various anesthesia techniques, which could help
The document discusses concepts related to surgery including:
- The different types and purposes of surgery such as diagnostic, curative, restorative, palliative, and cosmetic.
- Factors that increase surgical risk such as age, medications, medical conditions, and lifestyle factors.
- The preoperative assessment process including medical history, physical exam, lab tests, and identifying potential issues or risks.
- Common nursing diagnoses related to surgery and the importance of patient education to address areas of deficient knowledge and reduce anxiety.
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
Nursing Assessment-History and Physical assessment - Musculoskelatal System/ ...Aby Thankachan
This document provides information on diagnostic tests and nursing interventions for musculoskeletal function assessment. It discusses tests such as arthrocentesis, arthroscopy, bone density tests, bone scans, CT scans, EMGs, MRIs, x-rays, and biopsies. For each test, it describes the purpose and relevant nursing interventions such as dressing care, activity restrictions, dietary restrictions, and monitoring for complications. It also discusses subjective and objective assessments including categories like history, symptoms, and physical exams of muscles, nerves, and vascular structures.
This document provides information about perioperative nursing care. It discusses types of surgeries, preoperative teaching and preparation, principles of sterile technique in the operating room, and anesthesia. Key points include identifying diagnostic, curative, palliative and cosmetic surgeries; emphasizing respiratory, cardiovascular and renal assessment preoperatively; explaining preoperative teaching goals and content; and outlining principles of sterile technique and regional anesthesia administration.
This document provides an overview of a medical surgical nursing course, including learning outcomes, assignments, grading, and textbook recommendations. It then provides a detailed overview of the main lecture on perioperative concepts and nursing management. The main lecture covers preoperative, intraoperative, and postoperative nursing care including patient assessment, classifications of surgical procedures, preoperative teaching, and the surgical phases.
The document discusses the care of surgical patients from pre-operation through recovery. It covers preparing the patient physically and psychologically for surgery, different types of surgeries and anesthesia, and the roles and responsibilities of staff in caring for surgical patients before, during, and after a procedure. Common patient fears are also addressed.
This document discusses ambulatory and fast track anesthesia. It covers topics such as the benefits of ambulatory surgery including lower costs and greater efficiency. It describes different facility designs for ambulatory surgery and lists many common procedures that can be done on an outpatient basis. The document outlines considerations for patient selection and preoperative preparation including pharmacologic and non-pharmacologic techniques. It also discusses various anesthetic techniques for ambulatory surgery like general anesthesia, regional anesthesia, and monitored anesthesia care. Fast tracking approaches to minimize side effects like PONV are also summarized.
Surgeon Champion Call 2010 - Dr Peter Dorismart1971
This document summarizes the journey of Surrey Memorial Hospital in implementing the ACS-NSQIP program to track surgical outcomes and improve quality. It describes initial challenges with data quality including missing data, coding errors and inconsistencies that were addressed through staff education and updated processes. It provides examples of pneumonia and catheter-associated urinary tract infection prevention initiatives that were undertaken using a team-based approach including practice changes, education and audits to reduce infection rates. Graphics show outcomes data over time comparing the hospital to NSQIP benchmarks.
This document summarizes a policy brief on increasing day surgery (ambulatory surgery where patients are discharged the same day). It discusses the history and growth of day surgery as a cost-effective alternative to inpatient surgery. While day surgery accounts for nearly 90% of surgeries in some countries, rates vary widely between countries and hospitals. The brief examines how expanding day surgery could benefit healthcare systems by increasing throughput, reducing costs and wait times. However, barriers still exist in some countries that prevent day surgery from reaching its full potential. Overcoming these barriers may require changes to policies, regulations, healthcare facilities and staffing.
Anesthesia carries risks that can lead to patient death or injury. Several factors contribute to risks in the operating room including equipment issues, patient health factors, human performance errors, and system failures. Some key errors that can cause severe harm are airway issues, medication errors, and procedure mistakes. Maintaining vigilance, checklists, standards, training, and learning from adverse events can help improve safety. Thorough documentation and review of incidents is important for quality assurance.
Structured Approach to Critically Ill and Injured Patientmetriccertain
CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and iNjury) is designed and developed to standardize the approach to the evaluation and treatment of acutely decompensating patients. The design and content was informed by the survey of clinicians from diverse international settings. Available in electronic (laptop/mobile) and paper formats, CERTAIN provides evidence based diagnostic checklists, clinical decision support, educational modules on performing critical procedures, and has the ability to time and document real-time interventions. CERTAIN prompting has been shown to improve performance of clinical providers faced with simulated emergencies.
This document discusses safe anesthesia practice and crisis management during anesthesia. It begins by defining safety for the anesthetist, surgeon, and patient. It then outlines international standards for safe anesthesia practice from 2010, including pre-anesthesia checks, monitoring during anesthesia, and crisis management protocols. Specific techniques are also discussed, such as managing a difficult airway and addressing laryngospasm. The presentation emphasizes protocols, checklists, skills, teamwork and communication to ensure patient safety.
This document discusses strategies to improve patient safety during anesthesia. It identifies that anesthesia can induce physiological changes that increase morbidity and mortality risks, so factors threatening safety in the operating room must be addressed. These factors include equipment issues, patient health problems, and human errors by anesthetists and surgeons. The document recommends developing preoperative plans, maintaining situational awareness during procedures, emphasizing teamwork and communication, avoiding production pressures, and fostering a learning culture where errors are reported and used to implement safety improvements.
Dental Implant 1 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Perioperative evaluation and management of surgicalFateme Roodsarabi
This document provides guidance on preoperative evaluation and management of patients undergoing elective surgery. It recommends focusing the evaluation on the patient's medical history and physical exam rather than routine screening tests. It provides criteria for when basic lab tests or specialist consultations are warranted based on a patient's health conditions and type of surgery. Guidance is given for the preoperative management of common patient populations like those with cardiac, pulmonary, renal or liver disease, diabetes, or who are pregnant/elderly.
The document discusses improving safety standards for office-based surgery and anesthesia. It notes a lack of uniform regulation has led to increasing complexity of cases performed in office settings. It introduces the Institute for Safety in Office Based Surgery, a non-profit established in 2009 to promote patient safety, develop tools for risk detection, and encourage physician education and evidence-based standards of care. It also references the high-profile case of Joan Rivers' death from complications during an outpatient procedure.
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and have minimal postoperative physiological disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and shorter-acting drugs that allow for faster recovery.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
This document discusses ambulatory anesthesia and day-care surgery. It provides a brief history of ambulatory anesthesia, noting key developments from 1903 to present day. It describes the objectives and techniques of anesthesia for day-care surgery, including premedication, induction agents, maintenance techniques, regional versus general anesthesia, advantages and disadvantages, selection criteria for patients, and discharge criteria. The success of day-care surgery depends on appropriate patient selection, facility availability, and type of surgical procedure.
This document provides biographical information about the editors of the book "Anesthesia in Day Care Surgery". M.M. Begani has over 40 years of experience as a surgeon in Mumbai, India. He helped pioneer the use of local anesthesia for day surgeries. Dheeraj V. Mulchandani is a consultant surgeon in Mumbai with extensive experience in general and laparoscopic surgery. Shagufta Choudhary is a consultant anesthesiologist who has dedicated her career to advancing ambulatory anesthesia and minimizing hospitalization time for day surgeries. The introduction emphasizes how this handbook aims to enable day surgeries across many specialties using various anesthesia techniques, which could help
The document discusses concepts related to surgery including:
- The different types and purposes of surgery such as diagnostic, curative, restorative, palliative, and cosmetic.
- Factors that increase surgical risk such as age, medications, medical conditions, and lifestyle factors.
- The preoperative assessment process including medical history, physical exam, lab tests, and identifying potential issues or risks.
- Common nursing diagnoses related to surgery and the importance of patient education to address areas of deficient knowledge and reduce anxiety.
The document discusses the importance of preoperative assessment and preparation of patients prior to surgery. Key aspects of assessment include taking a thorough medical history, conducting a physical examination, evaluating nutritional status, ordering relevant investigations, and determining surgical risk. Important elements of preparation are obtaining informed consent, preventing cardiovascular and respiratory complications, reducing risk of aspiration, preparing the bowels if needed, and ensuring adequate sleep, skin preparation, catheterization and pre-medication when applicable. The goals are to identify risk factors, optimize the patient's health status, and reduce postoperative complications.
Nursing Assessment-History and Physical assessment - Musculoskelatal System/ ...Aby Thankachan
This document provides information on diagnostic tests and nursing interventions for musculoskeletal function assessment. It discusses tests such as arthrocentesis, arthroscopy, bone density tests, bone scans, CT scans, EMGs, MRIs, x-rays, and biopsies. For each test, it describes the purpose and relevant nursing interventions such as dressing care, activity restrictions, dietary restrictions, and monitoring for complications. It also discusses subjective and objective assessments including categories like history, symptoms, and physical exams of muscles, nerves, and vascular structures.
This document provides information about perioperative nursing care. It discusses types of surgeries, preoperative teaching and preparation, principles of sterile technique in the operating room, and anesthesia. Key points include identifying diagnostic, curative, palliative and cosmetic surgeries; emphasizing respiratory, cardiovascular and renal assessment preoperatively; explaining preoperative teaching goals and content; and outlining principles of sterile technique and regional anesthesia administration.
This document provides an overview of a medical surgical nursing course, including learning outcomes, assignments, grading, and textbook recommendations. It then provides a detailed overview of the main lecture on perioperative concepts and nursing management. The main lecture covers preoperative, intraoperative, and postoperative nursing care including patient assessment, classifications of surgical procedures, preoperative teaching, and the surgical phases.
preoperative preparation of surgical patient tsedalemekete1
This document outlines a seminar on patient safety and preoperative preparation of surgical patients. It discusses key topics like prevalence of adverse healthcare events, strategies for improving patient safety including checklists, preoperative assessment of patients, specific preparation for common medical conditions, obtaining consent, and arranging operating lists. It also describes systems for assessing patient risk like the American Society of Anesthesiologists scoring system. The overall goal is to understand how to optimize patient safety and condition before surgery.
This document discusses awake tracheal intubation in the emergency department. It provides a brief history of awake intubation and outlines its benefits over rapid sequence intubation, including maintaining protective airway reflexes and avoiding risks of induction agents. The document also summarizes guidelines for patient selection, preparation, equipment, and outcomes of awake intubation. Key considerations include thorough airway assessment, use of cognitive aids, positioning to optimize oxygenation, and video laryngoscopy as an effective tool.
Hospital Dental Services for Children and the Use of General AnesthesiaAl-lehyani
“a drug-induced loss of consciousness
during which patients are not arousable, even by painful
stimulation. The ability to independently maintain ventilatory
function is often impaired. Patients often require assistance
in maintaining a patent airway, and positive-pressure
ventilation may be required because of depressed spontaneous
ventilation or drug-induced depression of neuromuscular
function. Cardiovascular function may be impaired.
An infection control nurse informed the PICU consultant that two patients have been found to have MDR Acinetobacter infections. This may constitute an Acinetobacter outbreak. The consultant should confirm it is an outbreak by investigating patients and the environment, calculating the attack rate, and comparing it to the background rate. If confirmed, treatment and prevention measures should be implemented, including isolation, cohorting, strict sterilization and disinfection procedures.
Non Obstetric Surgery in Pregnant Patients discusses considerations for anesthesia when performing non-obstetric surgery on pregnant patients. Anesthesiologists must provide safe anesthesia for both the mother and fetus by considering the physiological changes of pregnancy and avoiding fetal asphyxia, teratogenic drugs, and preterm labor. Regional anesthesia techniques like spinal or epidural blocks are preferred when possible due to advantages like limited drug exposure to the fetus. Surgery should generally be performed in the second trimester to balance maternal and fetal risks. Fetal monitoring is recommended during procedures to assess fetal well-being.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
General Preoperative &Postoperative Care of Surgical PatientsOmarAlaidaroos3
1. Preoperative evaluation and preparation of surgical patients involves a thorough history, physical exam, appropriate diagnostic testing, counseling and informed consent obtaining, optimization of medical conditions, and NPO status prior to surgery.
2. Intraoperative care focuses on anesthetic management and monitoring while postoperative care aims to monitor for complications, manage pain and encourage early mobilization through actions like incentive spirometry.
3. Common complications assessed and managed in the postoperative period include respiratory issues like atelectasis and pneumonia, infections, thromboembolic events, and other surgery-specific complications.
The document discusses a case study involving a patient named Mrs. Smith who suffered a stroke and is experiencing dysphagia and malnutrition. It outlines the nurse's initial and ongoing assessments of Mrs. Smith's condition, which include monitoring her vital signs, tube feeding site, nutritional status, and ensuring her readiness for discharge. The priority nursing diagnosis identified for Mrs. Smith is imbalance in nutrition less than body requirements.
This document provides information on peri-operative nursing care for patients undergoing surgery. It discusses the goals and assessments of the pre-operative phase, including physiological, psychological, and informed consent assessments. Nursing interventions are outlined to prepare the patient for surgery, manage their care and needs, and provide education on the surgical process. The pre-operative phase aims to optimize the patient's health and reduce surgical risks through thorough evaluation and preparation.
Here are the triage categories I would assign to each patient based on the information provided:
1. 30 year old male with a compound fracture of left femur, bleeding significantly. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
2. 44 year old male sitting up with chest pain without obvious injury. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
3. 28 year old female with fracture of left wrist. Resp. rate 22. Cap. refill less than 2 sec. Alert and oriented. Decides she can walk after all.
Category: MINOR
DAY-CARE SURGERY IN CHILDREN [Autosaved].pptxgauthampatel
DAY-CARE SURGERY IN CHILDREN
Children are excellent candidates for day care management as they are usually healthy and predominantly require minor or intermediate surgery of short duration.
This document provides guidelines for performing obstetric ultrasound examinations at various stages of pregnancy. It discusses indications, imaging parameters, and documentation requirements for first trimester, standard second/third trimester, limited, and specialized ultrasound exams. Key aspects include evaluating gestational sac features in the first trimester, assessing fetal anatomy and biometric measurements in later exams, and documenting important findings such as placental location and amniotic fluid levels. Adherence to these guidelines helps maximize detection of fetal abnormalities.
This document discusses guidelines for imaging pregnant women to minimize radiation risk to the fetus. It provides that for most extra-abdominal exams, the fetal radiation dose is less than 0.1 mSv and risks are only increased above 150 mSv. Exams of the abdomen/pelvis can deliver up to 25 mGy but rarely exceed risks. Proper screening and documentation of pregnancy status is important. Guidelines recommend explicit questioning and documentation of last menstrual period and fetal risks/benefits should be considered before higher dose exams. Increased awareness through signage is suggested.
This clinical practice guideline from the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides updated evidence-based recommendations for the pre-, intra-, and postoperative care of children ages 1 to 18 undergoing tonsillectomy. Tonsillectomy is one of the most common surgical procedures in children in the United States. The guideline aims to improve quality of care by identifying opportunities and making explicit recommendations regarding indications for surgery, perioperative management, counseling of patients and families, and outcomes assessment. Key changes from the previous guideline include new evidence, inclusion of consumer advocates, and additional or modified recommendations.
The research design refers to the overall strategy that you choose to integrate the different components of the study in a coherent and logical way, thereby, ensuring you will effectively address the research problem; it constitutes the blueprint for the collection, measurement, and analysis of data.
This document outlines the key components of preoperative assessment for anaesthesia, including:
1. Taking a thorough patient history to identify any medical conditions or risks that could impact anaesthesia or surgery.
2. Performing a physical exam, including a focused assessment of the airway.
3. Determining the urgency of the planned surgery and communicating with the surgical team.
4. Ordering relevant preoperative investigations or tests based on the patient's age, health status, and type of surgery. The goals are to minimize risk and optimize preparation for anaesthesia and surgery.
This document discusses neonatal resuscitation and the physiologic changes that occur at birth. It covers topics like fetal circulation, oxygenation, the transition at delivery, signs of a compromised newborn, resuscitative steps including providing warmth, clearing the airway, stimulation and ventilation. Positive pressure ventilation techniques like bag-mask ventilation are described. The importance of anticipating resuscitation needs, preparing appropriately, and understanding the heart rate response to determine next steps is emphasized. Maintaining normal body temperature and oxygen saturation targets are also addressed.
1. Guidelines for Pediatric Ambulatory Surgery
Elliot Krane, M.D.
Table of Contents
Introduction ...................................................................................................................................... 2
Patient Selection and Preparation ................................................................................................... 2
Preoperative Screening: .............................................................................................................. 2
Common problems that the anesthesiologist will face include:................................................ 2
Preoperative Laboratory Testing.................................................................................................. 4
Premedication. ............................................................................................................................. 5
Anesthesia Techniques and Agents for Ambulatory Surgery.......................................................... 6
General vs. General + Regional Anesthesia ............................................................................... 6
The Role of New and Old Inhalation Agents................................................................................ 6
Management of Side Effects and Pain ............................................................................................ 7
Nausea and Vomiting................................................................................................................... 7
Postoperative Analgesia .............................................................................................................. 8
References .................................................................................................................................... 10
List of Tables
Table 1. Decision Making for The Child with a URI........................................................................ 3
Table 2. Some Common Chronic Medical Conditions in Children in Ambulatory Surgery. ........... 4
Table 3. Recommended preoperative laboratory testing. .............................................................. 5
Table 4. Commonly used Oral Premedications for Children. ......................................................... 6
Table 5. Comparison of Inhalation Agents for the Ambulatory Setting. ......................................... 7
Table 6. Prevention of Nausea and Vomiting................................................................................. 8
2. Guidelines For Pediatric Ambulatory Surgery
Introduction
The utilization of same day surgery is increasing in virtually every medical center across the
country, driven by cost-containment forces that are largely beyond our control or influence.
Children are excellent subjects for ambulatory surgical procedures because they represent a
population that is largely healthy and free of chronic illness, they generally have caretakers
(called parents) who are capable of assisting them at home through the recovery period, and
because children would generally prefer to recover from their surgery in the comfort and security
of their home, rather than the more anxiety provoking hospital environment. However, an
inevitable result of this national trend is that we are seeing more chronic illness of childhood on
the day of surgery, thus challenging us to adequately assess and prepare children preoperatively,
devise and use anesthetic techniques that will enable our patients to be street-ready in a
minimum period of time, while minimizing side effects and complications of anesthesia that might
result in prolonged recovery room stays or inpatient hospitalization.
The most common procedures performed in the ambulatory setting in the community hospital are
otolaryngogic, primarily myringotomy and tube insertion, tonsillectomy, and adenoidectomy, as
well as common general surgical procedures including circumcision and inguinal herniorrhaphy.
In the busier medical center with a referral pediatric surgical practice, additional cases commonly
performed include eye muscle surgery, plastic repairs of cleft lips, urological procedures such as
hypospadias repair, gastrointestinal endoscopy, radiological imaging procedures, and cardiac
catheterization.
The purpose of this lecture is not to provide a broad overview of ambulatory surgery for children,
but rather to update the clinician on recent advances and developments in this changing field.
Patient Selection and Preparation
Preoperative Screening:
The preoperative evaluation of the child undergoing ambulatory surgery is not different from the
child undergoing inpatient surgery, and includes a full health assessment, physical examination,
laboratory testing where indicated, etc.
Preoperative screening clinics for adult patients have been shown to be highly effective in
eliminating unnecessary blood tests and radiographs, in reducing case cancellation, and in
optimizing the preoperative condition of the patient. Their utility in pediatric ambulatory surgery
seems intuitive, however there are no case series or studies that clearly establish their utility.
Because most children who are presenting for ambulatory surgery are healthy, and would be
classified ASA Physical Status 1 or 2, the preoperative screening clinic for children is primarily the
opportunity for providing patient education and desensitization of the child to the hospital
environment. Advanced ASA physical status does not preclude ambulatory surgery, but makes
preoperative screening highly desirable so that the medical condition of the patient is optimal on
the day of surgery.
Common problems that the anesthesiologist will face include:
The child with an intercurrent respiratory infection (URI)
Few questions in pediatric anesthesia prove to be so contentious and so frequent as what to do
with the child with a cold. Economic forces generally favor performing surgery: the family may
have taken time off from work to have surgery performed, relatives may have traveled from a
distance to assist in family matters around the time of surgery, insurance authorization has been
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3. Guidelines For Pediatric Ambulatory Surgery
obtained and may be time limited, surgeons have scheduled cases and have limited flexibility in
rescheduling, etc. However, the weight of existing evidence indicates that children with active or
recent upper respiratory infections have an increased incidence of adverse airway events,
although these events tend to be mild and self limited. [23,34,37] The decision to cancel surgery
of a child with an upper respiratory infection must take into consideration the following factors:
Table 1. Decision Making for The Child with a URI.
Factors favoring postponing surgery Factors favoring performing surgery
Purulent nasal discharge Clear "allergic" rhinorrhea
Upper airway stridor, croup Economic hardship on family
Lower respiratory symptoms (e.g.
Exigencies of insurance and scheduling
wheezing, rales)
Fever Few and short "URI-free" periods
Scheduled surgery may itself decrease
Infection control
frequency of URI’s (e.g. T&A)
The Former Premature Infant:
Children born prematurely (before 37 weeks gestation) have an increased risk of postoperative
apnea and episodes of desaturation. [16-18] While this is believed to be a consequence of
residual effects of general anesthesia on the immature brainstem, the etiology of this complication
is not fully defined, too little is known to recommend ambulatory surgery in this population even if
a pure regional anesthetic is delivered.
The age at which the infant achieves brainstem maturity and is no longer at risk for postoperative
apnea and arterial oxygen desaturation is not well defined, but is believed to be between 40 and
60 weeks of post-conceptional age. (The post-conceptional age is calculated as the sum of the
gestational age and the chronological age.) The existence of significant post-neonatal problems,
such as anemia, bronchopulmonary dysplasia, seizures, etc., make the infant more apnea-prone
and should further delay surgery conducted on an ambulatory basis. Ambulatory surgery is
therefore not appropriate in this population until this age has been reached, and surgery should
either be performed on an inpatient basis with careful respiratory monitoring in the postoperative
period, or should be delayed.
The Child with Sleep Apnea:
The commonest indication for tonsillectomy in children younger than 3 or 4 years of age is severe
upper airway obstruction with or without sleep apnea. Children in this category have altered
control of respiration because of chronic nocturnal hypoxia and hypercarbia, and respond in an
unpredictable fashion to residual anesthetics and opioid medications in the recovery room.
Furthermore, while one would expect airway obstruction and sleep apnea to rapidly resolve after
removal of the tonsils, virtually all patients in this category have residual significant upper airway
obstruction in the postoperative period that resolves over several days, and as many as 35% of
children will ultimately not have significant improvement in sleep airway obstruction. These
children are therefore not candidates for ambulatory surgery. Recently a study from Johns
Hopkins Hospital demonstrated that children with (1) mild sleep apnea, (2) over the age of 4, and
(3) without complicating conditions such as Trisomy 21 or craniofacial anomalies could be
discharged home after tonsillectomy, while children outside of this group generally required
electronic monitoring overnight after tonsillectomy.42
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4. Guidelines For Pediatric Ambulatory Surgery
The Child with a Chronic Illness:
An increasing number of children with chronic illnesses are being seen in the ambulatory surgery
setting. The following table illustrates a few of the more common problems that are seen, with
some associated medical and anesthetic considerations:
Table 2. Some Common Chronic Medical Conditions in Children in
Ambulatory Surgery.
Condition
Medical Considerations Anesthetic Considerations
• Preoperative determination
• Hepatic enzyme induction of LFT’s, anticonvulsant
• Hepatic toxicity of levels
Seizure disorders anticonvulsants • Resistance to non-
depolarizing NMB’s
• Pre– and intra–operative
• Steroid dependence bronchodilator Rx
Asthma
• Steroid augmentation
• Pre– and intra–operative
• Nutritional deficiency
bronchodilator Rx
• Chronic infection
• Intraoperative pulmonary
• Chronic lung disease
Cystic Fibrosis toilet
• Asthma
• Control of pulmonary blood
• Pulmonary hypertension
pressure
• Understanding anatomy of
• SBE prophylaxis
cardiac shunts
• Chronic diuretic therapy–
Congenital heart • Altered anesthetic gas
electrolyte alterations
disease uptake
• Digoxin therapy
• Avoidance of I.V. bubbles
Preoperative Laboratory Testing.
No routine testing is indicated in children. Rather, laboratory testing should be determined by the
anticipated surgical procedure and its associated complications, and the preoperative condition of
the child. Often, it is not necessary to subject the child to an additional venipuncture, rather blood
can be obtained after induction of anesthesia and during placement of the intravenous cannula,
for example to determine the hematocrit prior to tonsillectomy; other times, it is best to know the
results of preoperative laboratory testing before embarking on an anesthetic, for example, in
caring for children with complex or chronic disease states.
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5. Guidelines For Pediatric Ambulatory Surgery
Table 3. Recommended preoperative laboratory testing.
Preoperative Condition Laboratory Tests that may be Indicated
• Hct; Hemoglobin, sickle cell screen
• Hgb Electrophoresis if screen is
Black or Southeast Asian Ethnicity
positive or if anemic
• LFT’s; blood anticonvulsant levels
Chronic seizure disorder
• If history of CHF: CXR
• If diuretic Rx: Electrolytes
Congenital heart disease
• If Dig Rx: K+, Dig level
• Fasting blood glucose; Hgb-A1C
Diabetes mellitus
• Creatinine
History of solid organ transplantation
• Hct, platelet count; tests specific for
Leukemia or other malignancy Rx by toxicity of each chemotherapeutic
chemotherapy agent being used
• EKG
Pacemaker
• Hct
Prematurity
• Electrolytes, Ca++, Phosphate,
Renal failure BUN, creatinine, Hct
• CXR; LFT’s
Tuberculosis + anti–Tb therapy
Premedication.
Premedication of children is very useful in achieving a calm and cooperative patient who does not
struggle during induction of anesthesia, and in making the hospital experience less anxiety
provoking for parents, patient, and anesthesiologist alike. Premedication is therefore most
beneficial in the patient who is too young to voluntarily cooperate with the anesthesiologist,
typically the child between 7–9 months and 8–12 years of age. Between the ages of 3 and 12
years, parental presence during induction of anesthesia often obviates the need for any
premedication if the parents are calm and supportive and their presence will serve to calm the
child. Parental presence in the induction room or operating room is a technique used in an
increasing number of medical centers with success. [2,14,41]
Oral administration of midazolam has become the most often used premedicant in children,
although it remains a very expensive alternative. In a dose of 0.5 mg/kg mixed with a vehicle to
increase its palatability, it renders most children calm and cooperative while allowing them to
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6. Guidelines For Pediatric Ambulatory Surgery
maintain consciousness and airway reflexes. Other commonly used premedications are listed in
Table 4.
Table 4. Commonly used Oral Premedications for Children.
Agent, dose Characteristics Side Effects
Mild sedation, no increase in recovery
Midazolam, 0.5 mg/kg Anxiolysis, euphoria
time [6,22]
Meperidine, 6 mg/kg Analgesia, sedation Hypoventilation [33]
OTFC, 15-20 µg/kg Analgesia, sedation Nausea, itching, hypoventilation [8]
Ketamine, 5 mg/kg Dissociation, analgesia Dysphoria, hallucinations [1]
Anesthesia Techniques and Agents for Ambulatory Surgery
General vs. General + Regional Anesthesia
While regional anesthesia without general anesthesia or deep sedation is seldom a viable
alternative in children, regional anesthesia in combination with general anesthesia is frequently
used. Why? Regional anesthesia adds to the complexity and anesthesia time in anesthetizing
children, and also requires more time obtaining informed consent from the parents. Is this
investment in time and effort worth the trouble in a busy ambulatory setting? Yes: the time
investment up front is made up on the back end in several ways, including more rapid and
smoother emergence from anesthesia and therefore quicker egress from the operating room,
faster recovery times and discharge home from the hospital or surgery center, and greater
personal and patient/parent satisfaction. [11,30,32]
Suitable techniques for children include caudal blocks for surgery below the diaphragms, lumbar
epidural blocks for abdominal or chest wall surgery, ilio-inguinal/iliohypogastric nerve blocks for
herniorrhaphy and orchiopexy, penile nerve blocks for circumcision and hypospadias repair, and
axillary nerve blocks for arm and hand procedures. The reader is referred to reviews in this and
other volumes for details on the performance of these blocks.
The Role of New and Old Inhalation Agents.
In the past 2 years, 2 new inhalation agents have come to the American market, desflurane and
sevoflurane. Both are halogenated ether molecules that have several theoretical advantages over
the older agents in use: they are far less blood soluble than halothane and isoflurane, therefore
will produce faster inhalation inductions and more rapid arousal. Closer examination of the
features of these newer agents, however, fail to convincingly demonstrate a superiority over
halothane that clearly justifies the significant added expense.
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7. Guidelines For Pediatric Ambulatory Surgery
Table 5. Comparison of Inhalation Agents for the Ambulatory Setting.
Agent Recovery
Advantages Disadvantages
(MAC in kids) Characteristics
• Bradycardia and
• Cheapest;
hypotension at
• Acceptable for
deep inhalation
Halothane mask induction
levels Slowest
(1.5%) • Huge collective
• Sensitization to
experience
catecholamines
• More expensive • Coughing on
Isoflurane • Unpleasant induction and
emergence Second Slowest
(2%) irritating smell
• Expensive
• Rapid induction
• No
and emergence
demonstrative
• Acceptable for
advantage in
mask induction
PACU discharge
Sevoflurane • HR and BP
times [10] Second fastest
(2.5%) maintained
• Delirium and
during deep
agitation on
levels of
emergence [43,
anesthesia
44]
• Very Expensive
• Very Irritating To
Airway:
• Least soluble,
inappropriate for
most rapid
induction or
Desflurane emergence
mask Fastest
(6%) • May reduce
administration
recovery time [4]
• Delirium and
agitation on
emergence [4]
A reasonable approach to these agents might be to use sevoflurane for induction, to take
advantage of its more rapid induction rate and more stable cardiovascular profile than halothane,
then to switch to a more economical agent such as halothane or isoflurane for maintenance of
and emergence from anesthesia.
Management of Side Effects and Pain
Nausea and Vomiting
Beside pain, there is probably no more uncomfortable and distressing side effect of surgery and
anesthesia than nausea and vomiting. Furthermore, several procedures commonly performed in
the pediatric ambulatory setting are notable for very high rates of nausea and vomiting,
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8. Guidelines For Pediatric Ambulatory Surgery
approaching 70% in unmedicated and untreated children. These include tonsillectomy, middle ear
surgery, and eye muscle (strabismus) surgery. [3,15,21] Other risk factors have been defined for
nausea and vomiting. Nausea and vomiting is less common in children under 3 years of age, and
is more common in females than males, and in patients who are encouraged or required to drink
fluids prior to discharge from the recovery room. [36]
Several agents have been tried and tested over the past decade for the prevention of nausea and
vomiting. Of these, droperidol is probably the least appropriate because it results in only a modest
improvement in the frequency of nausea, while producing enough sedation so as to delay recover
room discharge. [19,24,38] Metoclopramide, while not sedating, produces only a modest
reduction in the incidence of nausea and vomiting. [7,19,24].
The literature is convincing that neither droperidol nor metoclopramide is as effective as
ondansetron in the prevention of nausea and vomiting. [5,9,25,26,31,35,38,39] Finally, the
literature is also convincing that alternative techniques are effective in reducing nausea and
vomiting, including the selection of propofol as the anesthetic maintenance agent [3,13,20,27,40],
and the avoidance of opioid analgesics in favor of nonsteroidal anti-inflammatory analgesics.
[28,29,39]
Table 6. Prevention of Nausea and Vomiting
Agent, dose, cost per Side Effects,
Effect
mg cost for 30 kg patient
Droperidol, 0.075 mg/kg Sedation, extra-pyramidal effects
Moderate > Placebo
$0.09/mg $0.20
Metoclopramide, 0.1–
Infrequent extra-pyramidal effects
0.25 mg/kg. Moderate > Placebo
$0.12
$0.02/mg
Ondansetron, 0.1
Very effective > Headache
mg/kg,
Placebo $12
$4/mg
Propofol anesthesia Very effective >
$37/hour of anesthesia
$25 per 20cc ampule Placebo
Postoperative Analgesia
Management of postoperative pain is an important feature of successful ambulatory anesthesia.
The prevention of postoperative pain by the use of local anesthetic nerve blocks or local
infiltration, or the intraoperative administration of one or more of the agents in Table 5, provides
for smoother emergence from anesthesia and less agitation in the recovery room, and
theoretically will inhibit central nervous system windup. The reactive administration of analgesics
in the recover room is never as satisfactory as the prevention or obtundation of pain before it is
perceived by the child.
In addition to the regional anesthesia techniques discussed above, alternatives for pain
management include the following:
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9. Guidelines For Pediatric Ambulatory Surgery
Table 7. Pain Management Techniques.
Technique Advantages Disadvantages
Acetaminophen Effective for mild to Slow onset with rectal or oral
moderate pain administration
30 –45 mg/kg p.r.,
Useful primarily as Should be administered
10-20 mg/kg p.o. adjunctive agent preoperatively or early in surgery
NSAID’s, Increases bleeding associated with
Effective for moderate
Ketorolac tonsillectomy [12,28]
pain
(Toradol®)
Contraindicated in the presence of
No nausea or vomiting
0.9 mg/kg I.V. asthma or renal disease
Associated with nausea and
Intravenous
Very effective for vomiting [39]
Opioids
moderate to severe
pain Sedation; requires monitoring after
Morphine 0.1 mg/kg
administration
Effective for moderate
to severe pain
Oral Opioids Associated with nausea and
Oral preparation
vomiting, constipation
Codeine, 0.5 mg/kg,
May be administered at
Tylenol with Codeine® contains a
home
Hydrocodone sub-therapeutic dose of
(Lortab®), 0.2 mg/kg acetaminophen
Lortab® elixir contains
a therapeutic
acetaminophen dose
Reduces requirement Neuraxial blocks may delay
for general anesthesia ambulation of older children
Regional
No nausea, vomiting Older children may object to having
Anesthesia
numb extremities
Eliminates need for
opioids Time-limited duration of action
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10. Guidelines For Pediatric Ambulatory Surgery
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