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Postanesthesia care recovery and management

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Handbook of Ambulatory Anesthesia

Abstract

Anesthesia for ambulatory surgical patients is conducted in a variety of clinical settings. The specifics of each facility’s environment will determine the characteristics of the setting for postoperative care. Ambulatory patients may be fully integrated with inpatients in the main operating room of a full-service hospital, handled in segregated operating rooms within a hospital, or cared for in a separate hospital-affiliated or freestanding building. These arrangements affect patient selection, the type of surgery offered, and management of the recovery process. The following discussion will focus on generic aspects of postanesthesia care for the ambulatory patient which must be adapted for individual institutional circumstances.

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References

  1. Dexter F, Epstein R, Marcon E, de Matta R. Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms. J Perianesth Nurs. 2005;20:92–102.

    Article  PubMed  Google Scholar 

  2. Pavlin DJ, Rapp SE, Polissar NL, et al. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87:816–26.

    Article  CAS  PubMed  Google Scholar 

  3. Claxton AR, McGuire G, Chung F, Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg. 1997;84:509–514.

    Article  CAS  PubMed  Google Scholar 

  4. Joshi G, McCarroll S, O’Brien T, et al. Intraarticular analgesia following knee arthroscopy. Anesth Analg. 1993;76:333–336.

    CAS  PubMed  Google Scholar 

  5. Bridenbaugh L. Regional anaesthesia for outpatient surgery—a summary of 12 years’ experience. Can Anaesth Soc J. 1983;30:548–552.

    Article  CAS  PubMed  Google Scholar 

  6. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100:757–773.

    Article  PubMed  Google Scholar 

  7. Woolf CJ, Chong MS. Pre-emptive analgesia: treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77:362–379.

    CAS  PubMed  Google Scholar 

  8. Wong H, Carpenter R, Kpacz D, et al. A randomized double-blind evaluation of ketorolac tromethamine for post-operative analgesia in ambulatory surgery patients. Anesthesiology. 1993;78:6–14.

    Article  CAS  PubMed  Google Scholar 

  9. Sukhani R, Vasquez J, Pappas AL, et al. Recovery after propofol with and without intraoperative fentanyl in patients undergoing ambulatory gynecologic laparoscopy. Anesth Analg. 1996;83:975–981.

    Article  CAS  PubMed  Google Scholar 

  10. Ding Y, White P. Comparative effects of ketorolac, dezocine and fentanyl as adjuvants during outpatient anesthesia. Anesth Analg. 1992;75:566–571.

    Article  CAS  PubMed  Google Scholar 

  11. Marret E, Kurdi O, Zufferey P, Bonnet F. Effects of nonsteroidal antiinflamatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005;102:1249–1260.

    Article  CAS  PubMed  Google Scholar 

  12. Joshi G, Viscusi E, Gan T, et al. Effective treatment of laparoscopic cholecystectomy pain with intravenous followed by oral COX-2 specific inhibitor. Anesth Analg. 2004;98:336–342.

    Article  CAS  PubMed  Google Scholar 

  13. Recart A, Issioui T, White P. The efficacy of celecoxib premedication on postoperative pain and recovery times after ambulatory surgery: a dose-ranging study. Anesth Analg. 2003;96:1631–1635.

    CAS  PubMed  Google Scholar 

  14. Romsing J, Moiniche S, Mathiesen O, et al. Reduction of opioid-related adverse events using opioid-sparing analgesia with COX-2 inhibitors lacks documentation: a systematic review. Acta Anaesthesiol Scand. 2005;49:133–142.

    Article  CAS  PubMed  Google Scholar 

  15. White P. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101:S5–S22.

    Article  PubMed  Google Scholar 

  16. Kwok R, Lim J, Chan M, et al. Preoperative ketamine improves postoperative analgesia after gynecologic laparoscopic surgery. Anesth Analg. 2004;98:1044–1049.

    Article  CAS  PubMed  Google Scholar 

  17. Menigaux C, Guignard B, Fletcher D, et al. Intraoperative small-dose ketamine enhances analgesia after outpatient knee arthroscopy. Anesth Analg. 2001;93:606–612.

    Article  CAS  PubMed  Google Scholar 

  18. Adam F, Libier M, Oszustowicz T, et al. Preoperative small-dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy. Anesth Analg. 1999;89:444–447.

    Article  CAS  PubMed  Google Scholar 

  19. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg. 2004;98:153–158.

    Article  CAS  PubMed  Google Scholar 

  20. Unlugenc H, Gunduz M, Guler T, Yagmur O, Isik G. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol. 2005;22:386–391.

    Article  CAS  PubMed  Google Scholar 

  21. Menigaux C, Adam F, Guignard, et al. Preoperative gabapentin decreased anxiety and improves early functional recovery from knee surgery. Anesth Analg. 2005;100:1394–1399.

    Article  CAS  PubMed  Google Scholar 

  22. Lu L, Fine N. The efficacy of continuous local anesthetic infiltration in breast surgery: Reduction Mammoplasty and reconstruction. Plast Reconstr Surg. 2005;115:1927–1934.

    Article  CAS  PubMed  Google Scholar 

  23. Kairaluoma P, Bachmann M, Korpinen A, et al. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg. 2004;99:1837–1843.

    Article  PubMed  Google Scholar 

  24. Hadzic A, Karaca P, Hobeika P, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg. 2005;100:976–981.

    Article  CAS  PubMed  Google Scholar 

  25. Terheggen M, Sille F, Rinkes I, et al. Paravertebral blockade for minor breast surgery. Anesth Analg. 2002;94:355–359.

    Article  PubMed  Google Scholar 

  26. Williams B, Kentor M, Vogt M, et al. Economics of nerve block pain management after anterior cruciate ligament reconstruction. Anesthesiology. 2004;100:697–706.

    Article  PubMed  Google Scholar 

  27. Mulroy M. Advances in regional anesthesia for outpatients. Curr Opin Anaesthesiol. 2002;15:641–645.

    Article  PubMed  Google Scholar 

  28. Khoury G, Chen A, Garland D, et al. Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology. 1992;77:263–266.

    Article  CAS  PubMed  Google Scholar 

  29. Goodwin R, Amjadi F, Parker R. Short-term analgesic effects of intra-articular injections after knee arthroscopy. Arthroscopy. 2005;21:307–312.

    Article  PubMed  Google Scholar 

  30. Orkin F. What do patients want? Preferences for immediate postoperative recovery. Anesth Analg. 1992;74:S225.

    Google Scholar 

  31. Gan TJ, Sloan F, Dear G, et al. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg. 2001;92:393–400.

    Article  CAS  PubMed  Google Scholar 

  32. Gold BS, Kitz DS, Lecky JH, et al. Unanticipated admission to the hospital following ambulatory surgery. JAMA. 1989;262:3008–3010.

    Article  CAS  PubMed  Google Scholar 

  33. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102:1884–1898.

    Article  PubMed  Google Scholar 

  34. American Society of PeriAnesthesia Nurses PONV/PDNV Strategic Work Team. ASPAN’S Evidence-Based Clinical Practice Guideline for the Prevention and/or Management of PONV/PDNV. J Perianesth Nurs. 2006;21:230–250. Available at: http://www.aspan.org/ponv_pdnv_guidelines.htm. Accessed July 13, 2007.

    Article  Google Scholar 

  35. Apfel C, Laara E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology. 1999;91:693–700.

    Article  CAS  PubMed  Google Scholar 

  36. Koivuranta M, Laara E, Snare L, et al. A survey of postoperative nausea and vomiting. Anaesthesia. 1997;52:443–449.

    Article  CAS  PubMed  Google Scholar 

  37. Gan T, Meyer T, Apfel C, et al. Society for ambulatory anesthesia guidelines for the Management of postoperative nausea and vomiting. Anesth Analg. 2007;105:1615–28.

    Article  PubMed  Google Scholar 

  38. White P, Watcha M. Postoperative nausea and vomiting: prophylaxis versus treatment. Anesth Analg. 1999;89:1337–1339.

    Article  CAS  PubMed  Google Scholar 

  39. Apfel C, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350:2441–2451.

    Article  CAS  PubMed  Google Scholar 

  40. Wang J, Ho S, Tzeng J, et al. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg. 2000;91:136–139.

    Article  CAS  PubMed  Google Scholar 

  41. White P, Issioui T, Hu J, et al. Comparative efficacy of acustimulation versus ondansetron in combination with droperidol for preventing nausea and vomiting. Anesthesiology. 2002;97:1075–1081.

    Article  CAS  PubMed  Google Scholar 

  42. Kotani N, Hashimoto H, Sato Y, et al. Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement and sympathoadrenal responses. Anesthesiology. 2001;95:349–356.

    Article  CAS  PubMed  Google Scholar 

  43. Greif R, Laciny S, Rapf B, et al. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology. 1999;91:1246–1252.

    Article  CAS  PubMed  Google Scholar 

  44. Purhonen S, Turunen M, Ruohoaho U, et al. Supplemental oxygen does not reduce the incidence of postoperative nausea and vomiting after ambulatory gynecologic surgery. Anesth Analg. 2003;96:91–96.

    Article  CAS  PubMed  Google Scholar 

  45. Gan T, El-Molem H, Ray J, et al. Patient-controlled antiemesis: a randomized, doubleblind comparison of two doses of propofol versus placebo. Anesthesiology. 1999:90;1564–1570.

    Article  CAS  PubMed  Google Scholar 

  46. Gupta A, Wu CL, Elkassabany N, et al. Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery? A systematic review of randomized controlled trials. Anesthesiology. 2003;99:488–495.

    Article  PubMed  Google Scholar 

  47. Dimich I, Lingham R, Gabrielson G, et al. Comparative hemodynamic effects of labetalol and hydralazine in the treatment of postoperative hypertension. J Clin Anesth. 1989;1:201–206.

    Article  CAS  PubMed  Google Scholar 

  48. Kallar SK, Jones GW. Postoperative complications. In:White PF, ed. Outpatient Anesthesia. New York, NY: Churchill Livingstone; 1990:397–415.

    Google Scholar 

  49. Warner MA, Warner ME, Weber JG. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology. 1993;78:56–62.

    Article  CAS  PubMed  Google Scholar 

  50. Isaacson KB. Complications of hysteroscopy. Obstet Gynecol Clin North Am. 1999;26:39–51.

    Article  CAS  PubMed  Google Scholar 

  51. Slotman GJ, Jed EH, Burchard KW. Adverse effects of hypothermia in postoperative patients. Am J Surg. 1985;149:495–501.

    Article  CAS  PubMed  Google Scholar 

  52. Macintyre PE, Pavlin EG, Dwersteg JF. Effect of meperidine on oxygen consumption, carbon dioxide production, and respiratory gas exchange in postanesthesia shivering. Anesth Analg. 1987;66:751–755.

    Article  CAS  PubMed  Google Scholar 

  53. Yentis SM, Levine MF, Hartley EJ. Should all children with suspected or confirmed malignant hyperthermia susceptibility be admitted after surgery? A 10-year review. Anesth Analg. 1992;75:345–350.

    Article  CAS  PubMed  Google Scholar 

  54. Strazis KP, Fox AW. Malignant hyperthermia: a review of published cases. Anesth Analg. 1993;77:297–304.

    CAS  PubMed  Google Scholar 

  55. Philip BK. Patients’ assessment of ambulatory anesthesia and surgery. J Clin Anesth. 1992;4:355–358.

    Article  CAS  PubMed  Google Scholar 

  56. Ashworth J, Smith I. Comparison of desflurane with isoflurane or propofol in spontaneously breathing ambulatory patients. Anesth Analg. 1998;87:312–318.

    Article  CAS  PubMed  Google Scholar 

  57. Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89:1352–1359.

    Article  CAS  PubMed  Google Scholar 

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Pregler, J.L., Kapur, P.A. (2008). Postanesthesia care recovery and management. In: Twersky, R.S., Philip, B.K. (eds) Handbook of Ambulatory Anesthesia. Springer, New York, NY. https://doi.org/10.1007/978-0-387-73329-6_12

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  • DOI: https://doi.org/10.1007/978-0-387-73329-6_12

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-73328-9

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