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Outpatient anesthesia

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https://www.readbyqxmd.com/read/29772594/-upper-age-limit-in-outpatient-anesthesia-opportunities-and-risks
#1
Tobias Hüppe, Nicole Kneller, Alexander Raddatz
Ambulatory surgery in elderly patients continues to increase - avoiding hospitalization and thus postoperative cognitive dysfunction in older patients being its major objectives. An upper age limit in outpatient anesthesia does not exist to date. However, functional rather than chronological age is crucial in patient selection. In consensus discussion, baseline functional status should be evaluated regularly - defined as everyday behaviors necessary to maintain daily life and encompassing areas of physical, cognitive, and social functioning...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29763977/transforming-care-to-evidence-based-practice-with-scripted-messages-an-improvement-project-for-pain-management-in-outpatient-surgical-patients
#2
Lanell M Bellury, Karen Mullinax, Judi Mozingo, Berta Dantzler, Nancy McGee
BACKGROUND: Outpatient surgeries are common and most patients experience pain postoperatively requiring nursing attention to pain management. Scripting, recommended for consistent, targeted communication to improve patient satisfaction, has limited evidence to support its use. AIMS: To explore the effect of scripted messages on self-reported pain control and patient satisfaction with care in outpatient surgical patients. METHODS: A retrospective medical record review pre- and postintervention evaluated a pain management scripted message delivered at two time points (preoperatively and postoperatively)...
May 15, 2018: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/29750661/spontaneous-conversions-of-supraventricular-tachycardia-to-sinus-rhythm-in-children-after-premedication-with-intranasal-dexmedetomidine-a-case-report
#3
Magnus Hultin, Erik Sundberg
Intranasal dexmedetomidine administered as premedication before anesthesia and cardioversion appears to have the potential to facilitate the return of sinus rhythm. Two children, 3.5 and 1.5 years old, with recurrent supraventricular tachycardia in need of cardioversion have now on several occasions spontaneously returned to sinus rhythm within 20-40 minutes after intranasal administration of dexmedetomidine (4 μg/kg) with a mucosal atomization device. Both children were observed on all occasions at the pediatric outpatient clinic and could return home within 2 hours of cardioversion...
May 9, 2018: A&A practice
https://www.readbyqxmd.com/read/29738599/unanticipated-admission-following-outpatient-rotator-cuff-repair-an-analysis-of-18-061-cases
#4
Joseph A Gil, Wesley M Durand, Joey P Johnson, Avi D Goodman, Brett D Owens, Alan H Daniels
The objective of this investigation was to examine the characteristics that place patients at risk for unanticipated inpatient admission after outpatient arthroscopic rotator cuff repair. This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program data sets from years 2012 to 2015. Patients were included in the study based on the presence of a primary Current Procedural Terminology code for rotator cuff repair (23410, 23412, 23420, and 29827). Only outpatient, nonemergent, and elective procedures performed on patients with American Society of Anesthesiologists classification of 4 or less were considered...
May 8, 2018: Orthopedics
https://www.readbyqxmd.com/read/29723512/a-phase-iii-study-evaluating-the-efficacy-and-safety-of-remimazolam-cns-7056-compared-with-placebo-and-midazolam-in-patients-undergoing-colonoscopy
#5
Douglas K Rex, Raj Bhandari, Taddese Desta, Michael DeMicco, Cynthia Schaeffer, Kyle Etzkorn, Charles Barish, Ronald Pruitt, Brooks D Cash, Daniel Quirk, Felix Tiongco, Shelby Sullivan, David Bernstein
BACKGROUND: Remimazolam is an ultrashort-acting benzodiazepine. METHODS: We performed a randomized double-blind comparison of remimazolam to placebo for outpatient colonoscopy. This study design was a requirement of the U.S. Food and Drug Administration. An additional group was randomized to open-label midazolam administered according to its package insert instructions (randomization ratio for remimazolam:placebo:midazolam was 30:6:10). Study medications were administered under the supervision of the endoscopist, without any involvement of an anesthesia specialist...
April 30, 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29719126/randomized-controlled-trial-comparing-the-supraglottic-airway-to-use-of-an-endotracheal-tube-in-sinonasal-surgery
#6
Austin S Adams, Todd J Wannemuehler, Benjamin Hull, Jeffanie Wu, Rakesh K Chandra, Kate VonWahlde, Matthew S Shotwell, Stephen Harvey, Michael Higgins, Kelly McQueen, Justin H Turner
BACKGROUND: The supraglottic airway (SGA) represents an alternative to endotracheal intubation (endotracheal tube [ETT]) in many types of ambulatory surgery. Adoption of the SGA has progressed slowly in sinonasal surgery due to concerns about airway protection. The purpose of this study was to compare quality of life measures and indices of airway protection between patients undergoing sinonasal surgery who were ventilated via an SGA or ETT. METHODS: Patients undergoing outpatient sinonasal surgery were enrolled into a randomized, single-blind study in which patients would be ventilated with either an SGA or ETT...
May 2, 2018: International Forum of Allergy & Rhinology
https://www.readbyqxmd.com/read/29683003/assessment-of-a-lateral-nasal-wall-block-technique-for-endoscopic-sinus-surgery-under-local-anesthesia
#7
Grace M Scott, Chris Diamond, Damian C Micomonaco
Introduction With increasingly limited operative resources and patient desires for minimally invasive procedures, there is a trend toward local endoscopic procedures being performed in the outpatient clinic setting. However, there remain limited data supporting a technique to adequately anesthetize the lateral nasal wall and provide patient comfort during these procedures. The objective of this study is to assess the efficacy of a novel lateral nasal wall block for use in office-based endoscopic sinus surgery...
January 1, 2018: American Journal of Rhinology & Allergy
https://www.readbyqxmd.com/read/29678651/post-general-anesthesia-ultrasound-guided-venous-mapping-increases-autogenous-access-placement-rates
#8
C Y Maximilian Png, Adam Korayem, David J Finlay
OBJECTIVE: This study investigates the impact of introducing a post-general anesthesia ultrasound mapping (PAUS) on the type of vascular access chosen for hemodialysis in patients without previous accesses. METHODS: 203 of 297 consecutive patients met inclusion criteria and were reviewed. Within-subjects analysis was performed on patients with both an outpatient ultrasound-guided vein mapping and a PAUS using sign tests and Wilcoxon signed ranked tests. Further, a between-subjects analysis added patients with only the outpatient vein mapping; demographic and comorbidity data were analyzed using t-tests and chi-squared tests...
April 17, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29661153/improved-analgesia-and-reduced-post-operative-nausea-and-vomiting-after-implementation-of-an-enhanced-recovery-after-surgery-eras-pathway-for-total-mastectomy
#9
Catherine Chiu, Pedram Aleshi, Laura J Esserman, Christina Inglis-Arkell, Edward Yap, Elizabeth L Whitlock, Monica W Harbell
BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways have been shown in multiple surgical disciplines to improve outcomes, including reduced opioid consumption, length of stay, and post-operative nausea and vomiting (PONV). However, very few studies describe the application of ERAS to breast surgery and even fewer describe ERAS for outpatient surgery. We describe the implementation and efficacy of an Enhanced Recovery After Surgery (ERAS) pathway for total skin-sparing mastectomy with immediate reconstruction in an outpatient setting...
April 16, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29658980/relative-complications-and-trends-of-outpatient-total-shoulder-arthroplasty
#10
Armin Arshi, Natalie L Leong, Christopher Wang, Zorica Buser, Jeffrey C Wang, Peter S Vezeridis, David R McAllister, Frank A Petrigliano
Outpatient arthroplasty is an appealing option among select patient populations as a mechanism for reducing health care expenditure. The purpose of this study was to determine the nationwide trends and complication profile of outpatient total shoulder arthroplasty (TSA). The authors reviewed a national administrative claims database to identify patients undergoing TSA as outpatients and inpatients from 2007 to 2016. The incidence of perioperative surgical and medical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes...
April 16, 2018: Orthopedics
https://www.readbyqxmd.com/read/29629886/postoperative-nausea-and-vomiting-ponv-in-outpatient-repair-of-inguinal-hernia
#11
Piergaspare Palumbo, Sofia Usai, Chiara Amatucci, Valentina Taurisano Pulli, Giulio Illuminati, Francesco Vietri, Guglielmo Tellan
PURPOSE: Nausea and vomiting are among the most frequent complications following anesthesia and surgery. Due to anesthesia seems to be primarily responsible for post operative nausea and vomiting (PONV) in Day Surgery facilities, the aim of the study is to evaluate how different methods of anesthesia could modify the onset of postoperative nausea and vomiting in a population of patients undergoing inguinal hernia repair. METHODS: Ninehundredten patients, aged between 18 and 87 years, underwent open inguinal hernia repair...
2018: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/29628853/crohn-s-disease-associated-silent-aspiration-in-the-outpatient-setting-anesthesiologists-beware
#12
Christopher Snell, Scott Coleman, Michele Van Hal, Farshad Rashidian, Gary Okum, Michael Stuart Green
Every anesthesia provider fears aspiration of gastric contents during an anesthetic, and it may occur even in the absence of overt signs such as coughing or choking. Whether the aspiration is frank or silent, catastrophic and deleterious consequences may ensue. Therefore, familiarity with risk factors for silent aspiration is essential. Crohn's disease reportedly delays gastric emptying making these patients more susceptible to silent aspiration during surgery. Anesthesia providers must be cognizant of this risk and vigilant in the recognition to formulate a specific treatment plan preoperatively...
April 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29628726/abnormal-uterine-bleeding-evaluation-by-endometrial-aspiration
#13
Pratibha Singh
Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy...
January 2018: Journal of Mid-life Health
https://www.readbyqxmd.com/read/29628562/comparative-study-between-propofol-and-dexmedetomidine-for-conscious-sedation-in-patients-undergoing-outpatient-colonoscopy
#14
Harish Karanth, Sumesh Murali, Reshma Koteshwar, Vasanth Shetty, Karunakara Adappa
Introduction: Colonoscopy is a mildly painful procedure requiring conscious sedation. Though propofol is a widely used anesthetic agent in day-care procedures due to its rapid onset and quick recovery has a drawback of requiring resuscitation maneuvers more often than the conventional methods. Dexmedetomidine, a newly introduced, highly selective α2 -adrenergic receptor agonist possessing hypnotic, sedative, anxiolytic, sympatholytic, and analgesic properties with impressive safety margin, needs to be explored for use in conscious sedation for colonoscopy procedure among South Indian population...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29624026/preoperative-anxiety-and-implications-on-postoperative-recovery-what-we-can-do-to-change-our-history
#15
Dusica M Stamenkovic, Nemanja K Rancic, Milan B Latas, Vojislava Neskovic, Goran M Rondovic, Jennifer D Wu, Davide Cattano
Preoperative anxiety can influence the intensity of postoperative pain and anesthesia and analgesia requirement. In certain types of surgery, anxiety may even increase postoperative morbidity and mortality. The goal of this narrative review is to remind anesthesiologists that anxiety measurement using specific tools can be done in clinical practice, to present the implications of preoperative anxiety on postoperative patient recovery, and to acknowledge the importance of a dedicated anesthesia plan in the management of anxious adult patients...
April 5, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29622307/preoperative-evaluation-and-patient-selection-for-office-based-oral-surgery-anesthesia
#16
REVIEW
Stuart Lieblich
Provision of an outpatient anesthetic requires careful review of the patient's medical history along with salient aspects of the physical examination. The oral and maxillofacial surgeon may need to consult with the patient's medical providers to gain an understanding of the patient's potential risks for an adverse event. This article reviews key aspects of the patient evaluation so that an informed determination of suitability for an office anesthetic can be made.
May 2018: Oral and Maxillofacial Surgery Clinics of North America
https://www.readbyqxmd.com/read/29606892/management-of-abnormal-uterine-bleeding-focus-on-ambulatory-hysteroscopy
#17
REVIEW
Shilpa Kolhe
The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required...
2018: International Journal of Women's Health
https://www.readbyqxmd.com/read/29587128/direct-analysis-of-pathogenic-structures-affixed-to-the-tympanic-membrane-during-chronic-otitis-media
#18
Guillermo L Monroy, Wenzhou Hong, Pawjai Khampang, Ryan G Porter, Michael A Novak, Darold R Spillman, Ronit Barkalifa, Eric J Chaney, Joseph E Kerschner, Stephen A Boppart
Objective To characterize otitis media-associated structures affixed to the mucosal surface of the tympanic membrane (TM) in vivo and in surgically recovered in vitro samples. Study Design Prospective case series without comparison. Setting Outpatient surgical care center. Subjects and Methods Forty pediatric subjects scheduled for tympanostomy tube placement surgery were imaged intraoperatively under general anesthesia. Postmyringotomy, a portable optical coherence tomography (OCT) imaging system assessed for the presence of any biofilm affixed to the mucosal surface of the TM...
March 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29555497/formal-physical-therapy-may-not-be-necessary-after-unicompartmental-knee-arthroplasty-a-randomized-clinical-trial
#19
Yale A Fillingham, Brian Darrith, Jess H Lonner, Chris Culvern, Meredith Crizer, Craig J Della Valle
BACKGROUND: The purpose of this randomized clinical trial was to compare formal outpatient physical therapy (PT) and unsupervised home exercises after unicompartmental knee arthroplasty (UKA). METHODS: Fifty-two patients were randomized to 6 weeks of outpatient PT or an unsupervised home exercise program after UKA. The primary outcome was change in range of motion at 6 weeks with secondary outcomes including total arc of motion, Knee Society Score, Knee Injury and Osteoarthritis Outcome Score Jr, Lower Extremity Functional Scale, and Veterans Rands-12 score...
February 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29539652/small-bowel-capsule-endoscopy-and-device-assisted-enteroscopy-for-diagnosis-and-treatment-of-small-bowel-disorders-european-society-of-gastrointestinal-endoscopy-esge-technical-review
#20
Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
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