1. Dr CHANDRASHEKARA.C.R
Consultant Anaesthesiologist
NOVA MEDICAL CENTERS,SAGAR HOSPITALS,
BANGALORE
2. Anaesthesia
ď Day careanaesthesia/ ambulatory anaesthesia/ Office
based anaesthesia
ď 25 million surgeries per year -70 % ambulatory
surgeries,10% - children âIDEAL FOR DAY CARE
3. Development
ď Ether- Sevoflurane, Deflurane
ď Thiopentone- Propofol
ď Short acting muscle relaxants
ď Short acting yet potent analgesics
ď Open surgery to Laparoscopic surgery
ď Patient xx / Pain Abdomen
9. Procedure
ENT/Dental
OBG
ď D&E ď Myringotomies
ď D&C, Hysteroscopic ď Nasal and aural foreign body
D&C removal
ď Lap ovarian ď Adenotonsillectomy
cystectomy ď Mastoidecomy/tympanoplasty
ď Diagnostic lap Restoration
ď Others ď Extraction
10. NOT FOR DAY CARE
ď Active asthma/URTI/Difficult
Airway
ď CHF/IHD/Un controlled
HTN/Cardio myopathies
ď Uncontrolled DM
ď Morbid obesity
ď Haemorrhage/fluid shifts
ď ?Procedures more than 90
minutes
ď Prematures
11. Our Success
ď Proper Selection of cases
ď Pre-operative assessment /Stabilisation .
ď Well planned anaesthetic techniques/ modified?
ď Management of post-operative pain, nausea and
vomiting
ď Discharge according to protocol
ď Extended Day care facility
12. PAC
ď Premedication-
ď H2 receptor antagonists ,antacids,
analgesics,Steroids,Chest physiotherapy, Nebulisation
ď To continue other medications
ď Phy/Cardio/Endocrinology opinion
13. Anaesthesia
ďŽ Pre op counseling/
Premedication
ďŽ GA â LMA/ETT
ďŽ Propofol/Short acting
Relaxants
ďŽ OPIOD/Non opiod based
analgesia
ďŽ Local anaesthetics/ Nerve
blocks/ Epidurals
15. Pain-Multimodal approach
ď Targeting different
levels
ď Optimal pain relief
with minimal side
effect
ď Combination of
analgesics drugs and
techniques enhance
the analgesic level
16. Pain management
shorter discharge times, lower pain scores, and a lower incidence of nausea and
vomiting, compared with traditional opiate-based anesthetic techniques
17. Pain
ď IV Fentanyl-2 mic gms/kg bolus/1mic gms infusion
ď IV Paracetamol 20 mg/kg â upto 4 gms/day
ď ?IV Diclofenac upto 150 mg/ day
ď IV Ketorolac[0.8 mg/kg, max 60 mg- low pain score,
decreased opiods
ď Extended day care- Morphine, Pethidine
18. PONV
ď PONV distressing complication of ambulatory
anesthesia
ď Delayed discharge and unanticipated admissions
ď The role of Nitrous oxide in contributing to PONV is
unclear
ď Propofol- less nausea and vomiting than other
induction drugs with its rapid recovery profile
ď Neostigmine be associated with an increased
incidence of PONV
23. Figure 1. Most patients had recovered from anesthesia and were discharged home within 1â2
h after surgery.
Marshall S I , Chung F Anesth Analg 1999;88:508-508
Š1999 by Lippincott Williams & W ilkins