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

La sélection des patients en anesthésie ambulatoire — Une revue factuelle : partie II

Abstract

Purpose

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.

Source

Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I.

Principal findings

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.

Conclusion

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.

Résumé

Objectif

C’est la seconde revue qui évalue la prise en charge de patients, dont les pathologes médicales ont été ciblées, qui doivent subir une anesthésle en chirurgie ambulatoire. Les situations choisies comprennent: le diabète, l’obésité morbide, l’enfant né prématurément, l’enfant atteint d’infection des voles 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’évaluation 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 périopératoires mineures, ce qui n’augmente pas les admissions hospitalières imprévues. Lenfant 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 est plus à risque de complications respiratoires périopératoires, surtout si l’intubation endotrachéale est requise. Le patient souffrant d’hyperthermie maligne est admis en chirurgie ambulatoire, mais nécessite quatre heures de monitorage postopératoire de la température. Des cas sporadiques d’interactions de médicaments ont été signalés quand la mépéridine et des catécholamines à action indirecte sont administrées en présence d’inhibiteurs de la monoamine-oxydase. En l’absence de ces combinaisons, l’anesthésie et la chirurgie ambulatoires sont sans risque.

Conclusion

L’anesthésie ambulatoire peut être réalisée chez divers patients qui présentent des affections coexistantes importantes. Elle leur est d’ailleurs offerte. Dans de nombreux cas, il y a peu de preuve documentant l’évolution postopératoire attendue chez ces patients. Des études prospectives observationnelles et interventionnelles sont nécessaires pour mieux définir la prise en charge périopératoire.

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Correspondence to Gregory L. Bryson.

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Meeting facilities were sponsored by Purdue Pharma.

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Bryson, G.L., Chung, F., Cox, R.G. et al. Patient selection in ambulatory anesthesia — An evidence-based review: part II. Can J Anesth 51, 782 (2004). https://doi.org/10.1007/BF03018450

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Keywords

  • Metformin
  • Laryngeal Mask Airway
  • Moclobemide
  • Monoamine Oxidase Inhibitor
  • Malignant Hyperthermia