Patient selection in ambulatory anesthesia — An evidence-based review: part II

Abstract

P Pu ur rp po os se e: : This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors.S So ou ur rc ce e: : Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is > 60 weeks and hematocrit is > 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirectacting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided.C Co on nc cl lu us si io on n: : Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management. Objectif : C'est la seconde revue qui évalue la prise en charge de patients, dont les pathologies médicales ont été ciblées, qui doivent subir une anesthésie en chirurgie ambulatoire. Les situations choisies comprennent : le diabète, l'obésité morbide, l'enfant né prématurément, l'enfant atteint d'infection des voies respiratoires supérieures, l'hyperthermie maligne et l'usage d'inhibiteurs de la monoamine-oxydase. Source : Les stratégies de recherche dans Medline et le cadre de l'é-valuation de la preuve clinique sont présentés dans la partie I. Constatations principales : Le diabète n'a pas été relié à des événements indésirables à la suite d'une opération ambulatoire. Le patient très obèse est plus à risque de complications respiratoires péri-opératoires mineures, ce qui n'augmente pas les admissions hospitalières imprévues. L'enfant prématuré est admis en chirurgie ambulatoire si l'âge post-conception est > 60 semaines et si l'hématocrite est > 30 %. L'enfant qui a une infection récente des voies respiratoires supérieures

Resultados de un programa de cirugía mayor ambulatoria en oftalmología

“…Los estudios afirman que las complicaciones mayores no son frecuentes y la mortalidad es extremadamente baja (9,10) Los casos de infarto de miocardio, embolismos pulmonares y alteraciones cerebrales son extremadamente bajos, con una incidencia tan baja como la que puede ser esperada por la edad del paciente en grupos sin intervención quirúrgica (6,11,12). Los eventos suelen aparecer aproximadamente en los dos primeros días tras la intervención, aunque se estima que aproximadamente un 40% ocurrirán entre las 48 horas y el mes tras el acto médico (11,13).…”

“…En nuestro estudio, la causa más común de ingreso hospitalario deriva de las alteraciones del metabolismo de la glucosa, con resultados similares a otros autores (3,13,18). Los cuadros de vómitos y nauseas clásicamente se han considerado causas importantes de admisión hospitalaria (11,19).…”

Factors affecting recovery and discharge following ambulatory surgery

“…Malignant hyperthermia syndrome patients can undergo ambulatory surgery so long as a trigger-free anesthesic is provided, and body temperature is monitored and remains normal for a minimum of four hours postoperatively. 40 These recommendations are in keeping with the guidelines of the Malignant Hyperthermia Association of the United States and the Malignant Hyperthermia Association of Canada. 41,42 Prior to discharge, the MHS patient should be given written instructions as to how to monitor his/her temperature at home, and how to recognize signs of malignant hyperthermia, with contact details to seek medical advice if necessary.…”

Patient’s perspective during surgical and/or diagnostic procedures performed in day surgery in breast cancer patient. Psychological implications and care pathway quality assessment with a specific questionnaire and a quality score

“…As a consequence, a gradual increase of the procedures applied in DS has been observed. This has made important the establishment and the use of guidelines [2], especially for patient selection criteria [3][4][5].…”