At the 19th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 25, Rebecca Twersky, MD, of the ambulatory surgery unit at State University of New York Downstate Medical Center, discussed key trends in ambulatory anesthesia.
Top issues with anesthesia in ASCs include obstructive sleep apnea, drug shortages, post operative vomiting and nausea and post discharge vomiting and nausea.
OSA, or the partial or complete obstruction of the upper airway, is the number one sleep disorder for normal sleeping patients and can come into play while patients are sedated. This disorder, which is more prevalent in males, is undiagnosed in the majority of patients, Dr. Twersky said.
Proper pre-operative assessments can detect patients who are at a high risk for OSA or the co-morbidities associated with the disorder, including the prevalence of hypertension or heart failure and a higher risk of stroke.
"[OSA] requires more intense perioperative management. Is it feasible in an ASC? If you have the resources and have the comfort level to manage those resources," she said. "You have to consider the type of anesthesia, the nature of the surgery and the level of home care. Patients with moderate to severe risk may not be appropriate for a free-standing ASC."
Shortages of propofol in particular, the drug used most often for rapid onset and little side effects, have posed challenges for ASC anesthesiologists. Dr. Twersky encourages physicians to think outside of the normal routes for creative sedation with available resources. This could include a combination of sedatives and local anesthesia.
Post operative nausea and vomiting still impact ASC patients, but post discharge nausea and vomiting are becoming more of a problem. Indentify patients who may be at greatest risk for PDNV, she said, including young females and people who have a history of it. Also, select longer-lasting antiemetic drugs that last for 48 to 72 hours to combat vomiting and nausea after release from the ASC.
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Top issues with anesthesia in ASCs include obstructive sleep apnea, drug shortages, post operative vomiting and nausea and post discharge vomiting and nausea.
OSA, or the partial or complete obstruction of the upper airway, is the number one sleep disorder for normal sleeping patients and can come into play while patients are sedated. This disorder, which is more prevalent in males, is undiagnosed in the majority of patients, Dr. Twersky said.
Proper pre-operative assessments can detect patients who are at a high risk for OSA or the co-morbidities associated with the disorder, including the prevalence of hypertension or heart failure and a higher risk of stroke.
"[OSA] requires more intense perioperative management. Is it feasible in an ASC? If you have the resources and have the comfort level to manage those resources," she said. "You have to consider the type of anesthesia, the nature of the surgery and the level of home care. Patients with moderate to severe risk may not be appropriate for a free-standing ASC."
Shortages of propofol in particular, the drug used most often for rapid onset and little side effects, have posed challenges for ASC anesthesiologists. Dr. Twersky encourages physicians to think outside of the normal routes for creative sedation with available resources. This could include a combination of sedatives and local anesthesia.
Post operative nausea and vomiting still impact ASC patients, but post discharge nausea and vomiting are becoming more of a problem. Indentify patients who may be at greatest risk for PDNV, she said, including young females and people who have a history of it. Also, select longer-lasting antiemetic drugs that last for 48 to 72 hours to combat vomiting and nausea after release from the ASC.
More Articles on Anesthesia:
4 Key Areas for Anesthesia Groups to Achieve the Highest Quality of Care
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ASA Continues to Monitor CMS Proposed Medicare Fee Schedule Rule