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    2a. Outpatient Anesthesia

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    Junjungan Kristianto Manurung
    This document discusses outpatient anesthesia, also known as day-stay or ambulatory anesthesia. It provides information on the general and specific objectives of understanding outpatient anesthesia. The advantages of day-stay surgery are outlined as shorter wait times, avoiding psychological trauma of hospitalization, and lower costs. Patient selection criteria, pre-anesthesia preparation and evaluation, anesthesia techniques, monitoring during surgery, post-operative considerations, and discharge criteria are summarized. The importance of safety throughout the entire outpatient anesthesia process is emphasized.

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    2a. Outpatient Anesthesia

    Uploaded by

    Junjungan Kristianto Manurung
    158 views26 pages
    This document discusses outpatient anesthesia, also known as day-stay or ambulatory anesthesia. It provides information on the general and specific objectives of understanding outpatient anesthesia. The advantages of day-stay surgery are outlined as shorter wait times, avoiding psychological trauma of hospitalization, and lower costs. Patient selection criteria, pre-anesthesia preparation and evaluation, anesthesia techniques, monitoring during surgery, post-operative considerations, and discharge criteria are summarized. The importance of safety throughout the entire outpatient anesthesia process is emphasized.

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    This document discusses outpatient anesthesia, also known as day-stay or ambulatory anesthesia. It provides information on the general and specific objectives of understanding outpatient anesthesia. The advantages of day-stay surgery are outlined as shorter wait times, avoiding psychological trauma of hospitalization, and lower costs. Patient selection criteria, pre-anesthesia preparation and evaluation, anesthesia techniques, monitoring during surgery, post-operative considerations, and discharge criteria are summarized. The importance of safety throughout the entire outpatient anesthesia process is emphasized.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    158 views26 pages

    2a. Outpatient Anesthesia

    Uploaded by

    Junjungan Kristianto Manurung
    This document discusses outpatient anesthesia, also known as day-stay or ambulatory anesthesia. It provides information on the general and specific objectives of understanding outpatient anesthesia. The advantages of day-stay surgery are outlined as shorter wait times, avoiding psychological trauma of hospitalization, and lower costs. Patient selection criteria, pre-anesthesia preparation and evaluation, anesthesia techniques, monitoring during surgery, post-operative considerations, and discharge criteria are summarized. The importance of safety throughout the entire outpatient anesthesia process is emphasized.

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    Outpatient Anesthesia

    Dr. Kohar Hari Santoso, dr. SpAn. KIC.KAP


    Lila Tri Harjana, dr. SpAn.
    Anestesiologi & Reanimasi
    FK Unair / RSUD Dr. Soetomo
    Tujuan Instruksional Umum
    Memahami Anestesia Rawat Jalan

    Tujuan Instruksional Khusus


    setelah mengikuti sesi ini peserta akan dapat:
    1. Menyebutkan pengertian anestesia rawat jalan
    2. Menjelaskan keuntungan anestesia rawat jalan
    3. Menjelaskan kriteria pasien untuk anestesia
    rawat jalan
    4. Menjelaskan persiapan pra anestesia
    5. Menjelaskan tehnik anestesia rawat jalan
    6. Menjelaskan pengelolaan pascaanestesia
    Mean & Synonims

    • Anesthesia procedure without hospital


    admission for day-stay surgery.
    • Day case anesthesia
    • One day service anesthesia
    • Ambulatory anesthesia
    • Anestesia Rawat Jalan
    • Anestesia tanpa mondok
    Advantages of day-stay surgery
    • Shorter waiting time for operation
    • Avoids psychological trauma of prolonged
    separation from parents and home
    • Shortens inpatient operation waiting lists
    • Lower infection rate
    • No “hotel” cost and lower nursing cost
    • No night or weekend duty
    • No repeated hospital visiting
    Patient Case Selection
    • Less than 1 hour surgical procedure
    • Undue haemorrhage
    • Without severe post operative pain
    • Fitness rating of ASA grade I or II
    • Mostly for Diagnostic Procedure
    • Mostly at Non-operating Room
    Anesthesia (NORA) or Office-based
    Anesthesia (OBA)
    Instruction for the patient
    • Fasten preanesthesia
    • Identified current medication & allergy
    • Be accompanied at home & to hospital
    • Abstain from alkohol & smoke
    • Not drive a car or work machinery for 3 days
    Preoperative evaluation
    • Taking Medical history
    • Physical & laboratory evaluation
    • Explanation anesthesia plan
    • Informed consent
    Preanesthesia preparation
    • Patient preparation
    • Readiness Equipment
    • Drugs & agent choicing

    The aim of anesthesia is safety.


    Safety is begin with meticulous
    preoperative evaluation
    Preanesthesia fasten

    AGE Milk & Food Clear Water


    < 6 months 4 hours 2 hours
    6 – 36 months 6 hours 3 hours
    > 36 months 8 hours 3 hours

    Unfasten not reason to postpone emergency operation


    The aim of Infusion

    • IV line for drugs & emergency situation


    • Maintenance
    • Replacement

    What’s wrong in this


    infusion technique ?
    Drugs & agent choicing
    1. Short on set
    2. Short Duration
    3. Minimally hang over
    Anesthesia Technique Considerations
    • Premedication
    • General or Regional Anesthesia ?
    • Intravenous anesthetic drug
    • Volatile anesthetic agent
    • Masker or intubation ?
    • Monitoring during anesthesia
    • Operation procedure or technique
    Monitoring During Surgery
    • Secure the airway • Anesthesia Machine
    • Breathing adequaty • Agent anesthesia
    • Hemodynamic stability • IV line
    • Level of unconciousness • Estimated Blood Loss
    • Urine prodction ( if use • Surgical field
    catteter) • Environment theatre
    What happen in this picture ?
    Postoperative Consideration
    • Physiology evaluation
    • Analgesic
    • Realimentation
    • Mobilisation & Discharge

    Don’t give pillow


    For unconcious
    patient
    Realimentation

    • Conciuosness
    • Gastrointestinal Assessment
    • Gradual( MSS = minum sedikit sedikit)
    Gastro Intestinal segmentation
    1. Upper
     esofagus – lambung
    (pylorus )
    2.Middle
     Usus halus
    (s/d ileo caecal junction )
    3. Lower
     Caecum – colon – sigmoid -
    rectum
    Assessment GI Function

    Part of GI Signs

    Upper Nausea & Vomiting


    NG tube production
    Middle Peristaltic sounds

    Lower Flatus
    Complications

    • Headache • Dizziness
    • Drowsiness • Sore Throat
    • Nausea • Injection site pain
    • Vomiting • Muscle stiffness
    Risk factors for PONV

    • Patient Factors
    • Anesthetic techniques
    • Surgical Procedures
    Patient factors
    • Young age
    • Female gender, particularly if menstruating on
    day of surgery or in first trimester of
    pregnancy
    • History of prior postoperative emesis
    • History of motion sickness
    • Delayed gastric emptying (eg. Obesity )
    Anesthetic Technique Factors
    • Opioid administration
    • General anesthesia
    • Anesthetic drugs
    • Post operative pain
    • Hypotension
    Surgical Procedure Factors
    • Strabismus surgery
    • Ear surgery
    • Laparoscopy
    • Orchidopexy
    • Ovum retrieval
    • Tonsilectomy
    Discharge Criteria
    • Orientation to person, place and time
    • Stable vital signs for 30 – 60 minutes
    • Ability to ambulate unassisted
    • Ability to tolerate oral fluids
    • Ability to void
    • Absence of significant pain or bleeding
    Take Home Message
    The standards of anesthesia care and
    patient monitoring are the same
    regardless of location
    Thank you

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