Anaesthesia for day case surgery. Review

Abstract

Discharging patients from day case surgery (DCS) units at day of procedure makes high demands on staff professionalism. With DCS development, both lists of surgical operations and their complexity are progressively increasing. Selection of patients for surgical treatment in DCS is based on patient’s condition and stability of chronic diseases. Upon admission to DCS of Scandinavian countries, there is no need for blood tests, ECG or X-ray. Questionnaires filled in by patients help anaesthesiolo-gists identify almost all pathology that affect safe anaesthesia, and additional examination methods are used at doctor’s discretion. Multimodal premedication is the basis for postoperative analgesia. Premedication with sedatives is indicated mainly for children. For the safe treatment of patient, the correct and logical DCS organisation is much more important than the type of anaesthesia used in this department. However, the choice of anaesthesia can significantly affect the manifestation of side effects, the time of restoration of the patient's normal functionality and, ultimately, the duration of the patient's stay in DCS. Spinal anaesthesia is safe and easy to perform, but its use in the DCS can lead to delays in the patient's discharge, and sometimes to need for hospitalisation. Inhalation anaesthetics increase significantly the number of patients (up to 30 %) with postoperative nausea, vomiting and chills. That why, total intravenous anaesthesia with Propofol and Remifentanil is the most commonly used in Scandinavian countries. Regional anaesthesia under ultrasound control provides effective postoperative analgesia. For the relief of acute postoperative pain, it is necessary to use low doses of intravenous opioids. Use of Clonidine as an adjuvant in postoperative pain treatment helps enhance the analgesic effect of opioids. Patient discharge from DCS should be based on established criteria.

Internal anesthetic audit using the registration of critical incidents during anesthetic procedures for «one-day surgery» in children

“…Until recently, in anesthesiology, a medical audit meant an analysis of the department's activities, the main criterion of which was to determine anesthesia-related mortality or, at best, the incidence of serious complications [8][9][10][11]. Currently, an internal anesthetic audit is understood a systematic evaluation (involving an analysis of specific clinical observations) of the quality of the anesthetic procedures and their compliance with the established protocols, as well as an assessment of the effectiveness of the implemented protocols and their suitability for achieving the set goals [12,13].…”