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1.
Br J Nurs ; 29(3): 160-164, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32053433

RESUMO

BACKGROUND: Hypothermia is a common problem in the surgical context and can lead to serious consequences for the patient and increased costs for society. AIMS: To study day-surgery patients' peripheral and core temperatures during the preoperative phase. METHODS: In total, 50 day-surgery patients participated in the study. Two sets of measurements of temperatures were made: core temperature and peripheral temperatures (two measuring points on the upper body and lower extremities respectively) were measured on arrival at the day-surgery unit, as well as on arrival at the operating theatre. The data were normally distributed and a paired t-test was used for statistical analysis. FINDINGS: Peripheral temperatures had significant changes, with measuring points on the upper body decreasing and measuring points on the lower extremities increasing in temperature. The results show no significant change in core temperature. CONCLUSION: The measurements show that 28% of the patients were below recommended preoperative temperature on arrival at the operating theatre. Further research is needed to study the development of body temperature perioperatively as well as at what point reheating interventions should be introduced.


Assuntos
Temperatura Corporal , Período Pré-Operatório , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Feminino , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Temperatura Cutânea , Adulto Jovem
2.
Instr Course Lect ; 69: 167-182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017727

RESUMO

Joint arthroplasty is increasingly being performed in ambulatory surgery centers (ASCs). Enabled by enhanced recovery protocols and multimodal pain management, and incentivized by the implementation of value-based payment models, this trend is projected to continue, with more than half of total joint replacements predicted to be outpatient by 2026.1 Like any advance in healthcare, this transition offers both new advantages and new challenges. ASCs provide opportunities to improve patient satisfaction and outcomes while lowering costs, but realizing these advantages requires a new level of presurgery preparation for both surgeons and patients. This chapter outlines key considerations for success when transitioning to performing joint arthroplasty at ASCs. Paramount among these are patient selection and preparation. Additional considerations include protocol optimization through data tracking and iterative refinement. A clear understanding of the differences in performing joints at an ASC versus a hospital outpatient setting enables surgeons to make the transition smoothly, maintain a high-quality patient experience, and deliver optimum outcomes.


Assuntos
Artroplastia de Substituição , Pacientes Ambulatoriais , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Ambulatórios , Assistência à Saúde , Humanos , Manejo da Dor
3.
Instr Course Lect ; 69: 575-582, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017752

RESUMO

Shoulder arthroplasty has traditionally been viewed as an inpatient procedure because of the inherent medical comorbidities associated with an aging population and the need for postoperative pain control. Recent studies have shown that in appropriately selected patients, shoulder arthroplasty procedures can be safely done as outpatient procedures and can deliver economic value in today's cost-conscious health care environment. Several factors help ensure a successful surgical outcome, including cooperation from the ambulatory anesthesia service, proper patient selection, and perioperative pain control. Postoperatively, provider availability is vital to complete a seamless patient experience. With appropriate algorithms and care plans in place, outpatient shoulder arthroplasty can be a safe and cost-efficient procedure. The advances pioneered by outpatient shoulder arthroplasty will also serve to benefit inpatient shoulder arthroplasty patients via improved pain control, perioperative education, and potentially decreased length of stay.


Assuntos
Artroplastia do Ombro , Idoso , Procedimentos Cirúrgicos Ambulatórios , Artroplastia , Humanos , Tempo de Internação , Pacientes Ambulatoriais , Seleção de Pacientes
4.
Ann Otol Rhinol Laryngol ; 129(2): 110-114, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31526022

RESUMO

OBJECTIVE: To determine the association between intraday timing of outpatient pediatric tonsillectomy and revisit outcomes and complications. STUDY DESIGN: Cross-sectional analysis of New York databases. SETTING: Ambulatory surgery, emergency department and inpatient hospital settings. SUBJECTS AND METHODS: The State Ambulatory Surgery, State Emergency Department and State Inpatient Databases for 2010-2011 were analyzed for revisits. Outcomes assessed were revisits for any reason, bleeding, acute pain or fever, nausea, vomiting and dehydration. The relationships between the hour of admission for surgery, the hour of discharge and the revisit outcomes were analyzed. RESULTS: The study included 33,611 children (mean age, 6.62 years; 45.7% female) and 62.0% were admitted in the early morning. Discharges were most common in the early afternoon (28.3%). Revisit rates were significantly higher for the early evening discharges (6.0%) versus late morning discharges (3.1%) (P < .001). Revisits for bleeding were 1.8% for discharge in the early evening versus 0.6% in the late morning (P < .001). Revisits for fever, nausea, vomiting or dehydration were 1.8% for discharge in the early evening versus 0.9% in the late morning (P = .002). Late afternoon admission was significantly associated with higher revisit rates (10.9%, P < .001). Bleeding revisits were highest for late afternoon admit hour (1.5%, P = .001). Revisits for acute pain were also highest for late afternoon admit hour (2.3%, P = .005). CONCLUSION: Revisit are significantly higher when the patient is discharged late. Late afternoon surgery is also significantly associated with higher revisit rates. Surgeons may wish to consider these findings when a late tonsillectomy or late discharge is anticipated post-tonsillectomy.


Assuntos
Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Tonsilectomia , Procedimentos Cirúrgicos Ambulatórios , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Tempo
5.
Orthop Clin North Am ; 51(1): 1-5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739873

RESUMO

Using an age- and comorbidity-matched cohort, we compared patients who underwent unicompartmental knee arthroplasty in an ambulatory surgery center with those who underwent the procedure in a traditional hospital inpatient setting. Postoperatively, the ambulatory surgery center cohort had fewer major complications than the inpatient cohort. No ambulatory surgery center patients required acute hospital admission and none had major complications. Four major complications occurred in the inpatient cohort. There was no difference in complication rates. Our results suggest that outpatient unicompartmental knee arthroplasty in a freestanding ambulatory surgery center is a safe and reasonable alternative to the traditional inpatient hospital setting.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Artroplastia do Joelho/economia , Análise Custo-Benefício/métodos , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(49): e18064, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804313

RESUMO

Many studies have reported the good outcomes of percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation (LDH). However, the majority of published studies on PELD showed an average hospital stay of 2 to 5 days. Thus, the purpose of this retrospective study was to evaluate and compare the clinical outcomes of patients undergoing PELD for LDH as day surgery with the outcomes of patients managed as inpatients.A total of 402 patients who underwent PELD for single-level LDH were included. The visual analog scale score (VAS) for leg and back pain, Oswestry Disability Index (ODI) score, and Macnab criteria were evaluated preoperatively and at 2 years postoperatively (final follow-up). Operation time, duration of hospital stay, cost, postoperative complications, and the rates of and reasons for delayed discharge and readmission were recorded and analyzed.The mean operative time was 45.8 ±â€Š8.4 minutes in the PELD-A (nonday surgery mode) group and 41.3 ±â€Š8.7 minutes in the PELD-D (day surgery mode) group (P = .63). The average duration of hospital stay was 2.8 ±â€Š1.1 days in the PELD-A group and 3.2 ±â€Š0.9 hours in the PELD-D group (P < .001). The average hospitalization expenses of the PELD-A and PELD-D groups were 28,090 ±â€Š286 RMB and 24,356 ±â€Š126 RMB (P = .03), respectively. In both groups, the mean VAS and ODI scores improved significantly postoperatively compared with the preoperative scores. The satisfactory result rate was 89.8% in the PELD-D group and 91.0% in the PELD-A group, without a significant difference (P = .68). The delayed discharge rate in the PELD-A and PELD-D groups was 8.20% and 8.43%, respectively (P = .93). The main reasons for delayed discharge were dysesthesia, neurologic deficit, nausea, headache and residential distance from the hospital. The overall readmission rates were 5.99% and 5.53% in the PELD-A and PELD-D groups, respectively (P = .85). The most common reasons for readmission were reherniation, sequestered herniation and pain.In conclusion, PELD is safe and effective for the treatment of LDH and can reduce medical costs as day surgery, and it thus warrants increased attention.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Discotomia Percutânea/métodos , Discotomia Percutânea/estatística & dados numéricos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Preços Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente , Desempenho Físico Funcional , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1118-1123, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874526

RESUMO

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto/normas , Protectomia/normas , Idoso , Canal Anal/cirurgia , Humanos , Reto/cirurgia
10.
J Surg Oncol ; 120(8): 1456-1461, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31680250

RESUMO

BACKGROUND AND OBJECTIVES: Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. METHODS: Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. RESULTS: Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics. CONCLUSIONS: Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported.


Assuntos
Analgésicos Opioides/administração & dosagem , Uso de Medicamentos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Remifentanil/administração & dosagem , Tireoidectomia , Adulto , Procedimentos Cirúrgicos Ambulatórios , Feminino , Humanos , Infusões Intravenosas , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Medição da Dor , Alta do Paciente , Período Pós-Operatório , Estudos Retrospectivos
11.
Plast Reconstr Surg ; 144(5): 836e-840e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688759

RESUMO

BACKGROUND: Many ambulatory surgery centers use body mass index as a screening tool to make admissions decisions because of complication risks associated with high-body mass index patients. The objective of this investigation was to evaluate perioperative complications in a cohort of high-body mass index patients undergoing hand and elbow surgery at an ambulatory surgery center. The authors' hypothesis was that anesthesia-related complications for this cohort would be similar to those of a normal-body mass index group. METHODS: The authors retrospectively reviewed data from all hand and elbow procedures performed on patients with a high body mass index (>40 kg/m). One hundred eighty-nine high-body mass index patients and 189 normal-body mass index patients were included in the analysis. RESULTS: The average weight-based dosage of propofol was similar in both groups but was lower in the high-body mass index group for midazolam and fentanyl. Two high-body mass index patients had oxygen desaturations in the postanesthesia care unit. No patients developed complications related to anesthesia. In the high-body mass index group, one patient developed hypotension in the postanesthesia care unit, was admitted to the emergency room for monitoring, but was discharged the following morning. CONCLUSIONS: Outpatient hand surgical care of high-body mass index patients can be performed safely. Body mass index alone should not be considered as an absolute contraindication for surgery. Careful patient selection, evaluation of comorbidities, and close involvement of the anesthesia and medical teams are critical. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Índice de Massa Corporal , Articulação do Cotovelo/cirurgia , Mãos/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Estudos de Coortes , Bases de Dados Factuais , Articulação do Cotovelo/fisiopatologia , Fentanila/administração & dosagem , Mãos/fisiopatologia , Humanos , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Valores de Referência , Estudos Retrospectivos , Medição de Risco
12.
Curr Opin Anaesthesiol ; 32(6): 714-719, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689267

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to discuss the optimal use of neuromuscular blocking agents (NMBA) during ambulatory surgery, and to provide an update on the routine use of neuromuscular monitoring and the prevention of residual paralysis. RECENT FINDINGS: The number of major surgical procedures performed in ambulatory patients is likely to increase in the coming years, following the development of laparoscopic and thoracoscopic procedures. To successfully complete these procedures, the proper use of NMBA is mandatory. The use of NMBA not only improves intubating conditions but also ventilation. Recent studies demonstrate that NMBA are much more the solution rather than the cause of airway problems. There is growing evidence that the paralysis of the diaphragm and the abdominal wall muscles, which are resistant to NMBA is of importance during laparoscopic surgery. Further studies are still required to determine when deep neuromuscular block [posttetanic count (PTC) < 5] is required perioperatively. There is now a consensus to use perioperatively neuromuscular monitoring and particularly objective neuromuscular monitoring in combination with reversal agents to avoid residual paralysis and its related morbidity (e.g. respiratory complications in the PACU). SUMMARY: Recent data suggest that it is now possible to obtain a tight control of neuromuscular block to maintain optimal relaxation tailored to the surgical requirements and to obtain a rapid and reliable recovery at the end of the procedure.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Bloqueio Neuromuscular , Bloqueadores Neuromusculares/uso terapêutico , Humanos , Monitoração Neuromuscular
13.
Acta Clin Croat ; 58(Suppl 1): 43-47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741558

RESUMO

Ambulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Nervos Espinhais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Analgesia , Analgésicos Opioides/uso terapêutico , Humanos , Manejo da Dor , Dor Pós-Operatória/etiologia
14.
Acta Clin Croat ; 58(Suppl 1): 62-66, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741561

RESUMO

Use of local infiltration anaesthesia with 2% lidocaine in combination with epinephrine 1/100000 in rhinoplasty and 0.25% levobupivacaine in this research as an adjunct to general anaesthesia is compared analysing the need for postoperative analgesia in rhinoplasty patients. 30 patients received lidocaine combined with epinephrine (LA) and other 30 patients received levobupivacaine (LB). Comparison is done with Visual Analogue Scale in 30 min and 1, 3, 6 h postoperatively. Also 24 h need for analgesic treatment was recorded. In conclusion postoperative analgesia in LB group with general anaesthesia was significantly prolonged (P = 0.038).


Assuntos
Anestesia Local , Anestésicos Locais , Levobupivacaína , Lidocaína , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Rinoplastia/efeitos adversos , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Analgésicos/uso terapêutico , Anestesia Geral , Anestesia Local/métodos , Método Duplo-Cego , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios , Estudos Prospectivos , Vasoconstritores/administração & dosagem , Adulto Jovem
15.
Acta Clin Croat ; 58(Suppl 1): 67-73, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741562

RESUMO

Purpose of this study was assessing of local infiltration analgesia (LIA) with levobupivacaine on the trend of acute postoperative pain and outcome in individuals who underwent rhinoplasty procedure and abdominoplasty performed in general anaesthesia. The research was conducted on 60 patients, of which 30 patients underwent rhinoplasty procedure and the other 30 patients underwent abdominoplasty procedure in general anaesthesia with LIA in "Bagatin" Polyclinic in the time period between 01.01.2014. and 01.01.2017. Postoperative analgesics doses on the same day of surgery were noted in 85% of participants who underwent an abdominoplasty procedure and in 45% of participants underwent rhinoplasty procedure. Patients who underwent abdominoplasty were discharged from the facility within 48 hours, while all patients who underwent rhinoplasty procedure were discharged on the same day of the surgery. During the first postoperative day patients who underwent a rhinoplasty procedure did not require analgesics, while only 3% of patients who underwent an abdominal liposuction procedure required an additional dose of analgesics. The research results had shown, when LIA was performed, the manifestation of acute postoperative pain and vomiting did not lead to prolonged stay in day surgery.


Assuntos
Analgesia/métodos , Anestesia Local , Anestésicos Locais , Levobupivacaína , Dor Pós-Operatória/prevenção & controle , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Analgésicos/uso terapêutico , Anestesia Geral/efeitos adversos , Feminino , Humanos , Tempo de Internação , Lipoabdominoplastia/efeitos adversos , Masculino , Manejo da Dor/métodos , Náusea e Vômito Pós-Operatórios/etiologia , Período Pós-Operatório , Rinoplastia/efeitos adversos , Adulto Jovem
16.
Am Surg ; 85(9): 956-960, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638506

RESUMO

Postoperative pain managed with opioids has contributed to the opioid crisis through overprescribing practices. We assessed opioid-prescribing habits and their use by patients undergoing surgery for cutaneous malignancies. An Institutional Review Board-approved retrospective analysis was conducted for patients who underwent skin cancer resection between January 2018 and June 2018. Data were collected from the electronic medical record, and opioid-related data were collected from patient interviews and state registries. There were 120 study participants (42 females and 78 males) with a median age of 67 years (range, 21-94 years). All received preincision local anesthetic: 64 had liposomal bupivacaine (LB) (53%) and 56 had non-LB bupivacaine (47%). Most participants (n = 88) used 0 opioids (73%), including 43 LB-anesthetic (67%) and 45 non-LB-anesthetic (80%). No significance was seen between those with a diagnosis of chronic pain, narcotic tolerance, an area of resection, and nodal sampling groups in opioid use. Four patients (3%) requested a refill. Of 105 prescriptions written for opioids, 99 had leftover opioids for an overprescribing rate of 94 per cent. This study suggests pain after skin cancer surgery is manageable with very limited opioid requirements. Our results support prescribing no more than five opioid tablets for postoperative pain control in patients undergoing resection for skin malignancies.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Analgésicos Opioides/uso terapêutico , Prescrição Inadequada/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Feminino , Humanos , Lipossomos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Retrospectivos , Sudeste dos Estados Unidos , Adulto Jovem
17.
Curr Opin Anaesthesiol ; 32(6): 735-742, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31567511

RESUMO

PURPOSE OF REVIEW: Ambulatory surgery plays a major role in cost-effective patient care without compromising patient safety and satisfaction. This concept improves the patient support and decreases the length of stay sometimes until ambulatory surgery. The aim of this review is to examine the current state of the art of anesthesia for thoracic ambulatory surgery. RECENT FINDINGS: Guidelines for enhanced recovery after thoracic surgery (ERATS) have recently been published. They can be safely implemented without increasing hospital readmission or mortality. Video-assisted thoracoscopy may be the best approach within a fast-track program. Anesthetic management should focus on combination of regional analgesia and general anesthesia techniques. General anesthesia should be performed with short acting agent and prevention of residual paralysis. Thoracic epidural analgesia is the gold standard technique for pain control after major thoracic surgery but not compatible with a quick hospital discharge. Thoracic paravertebral block, Serratus plane block, intercostal nerve block, and more recently erector spinae plane block have all been used with success for analgesia in thoracic surgery. CONCLUSION: ERATS program may lead to improved outcomes including decreased length of stay, but it is currently too early to show the impact on thoracic ambulatory surgery that concerned selected patients for lung resection.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia , Procedimentos Cirúrgicos Torácicos , Humanos
18.
Curr Opin Anaesthesiol ; 32(6): 720-726, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31567512

RESUMO

PURPOSE OF REVIEW: The present review aims to propose pharmacological strategies to enhance current clinical practices for analgesia in ambulatory surgical settings and in the context of the opioid epidemic. RECENT FINDINGS: Each year, a high volume of patients undergoes ambulatory surgery worldwide. The multimodal analgesia proposed to ambulatory patients must provide the best analgesic effect and patient satisfaction while respecting the rules of safety for ambulatory surgery. The role of nurses, anesthesiologists, and surgeons around said surgery is to relieve suffering, achieve early mobilization and patient satisfaction, and reduce duration of stay in hospital. Currently, and particularly in North America, overprescription of opioids has reached a critical level constituting a 'crisis'. Thus, we see the need to offer more optimal multimodal analgesia strategies to ambulatory patients. SUMMARY: These strategies must combine three key components when not contraindicated: regional/local analgesia, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs). Adjuvants such as gabapentinoids, N-methyl-D-aspartate receptor modulators, glucocorticoids, α2-adrenergic receptor agonists, intravenous lidocaine might be added to the initial multimodal strategy, however, caution must be used regarding their side effects and risks of delaying recovery after ambulatory surgery. Weaker opioids (e.g. oxycodone, hydrocodone, tramadol) could be used rather than more powerful ones (e.g. morphine, hydromorphone, inhaled fentanyl, sufentanil). This, combined with education about postoperative weaning of opioids after surgery must be done in order to avoid long-term reliance of these drugs.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgesia/métodos , Adulto , Humanos
19.
Hand Clin ; 35(4): 429-434, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31585603

RESUMO

Hand surgery does not have to be expensive. Substituting evidence-based field sterility for main operating room sterility and using wide-awake, local anesthesia, no tourniquet (WALANT) surgery instead of sedation makes hand surgery much more affordable worldwide. This article explains how North Americans collaborated with Ghanaian hand surgeons and therapists to establish more affordable hand care in Kumasi. It describes how multiple nonprofit organizations collaborate to create trans-Atlantic Webinars and a reverse fellowship program to share hand surgery and therapy knowledge between North American and Ghanaian hand care providers.


Assuntos
Cooperação Internacional , Ortopedia/organização & administração , Procedimentos Cirúrgicos Ambulatórios , Bolsas de Estudo , Gana , Humanos , Intercâmbio Educacional Internacional , Ortopedia/educação , Fisioterapia , Sociedades Médicas , Infecção da Ferida Cirúrgica/prevenção & controle
20.
J Bone Joint Surg Am ; 101(19): 1768-1774, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577682

RESUMO

BACKGROUND: As orthopaedic surgery moves toward bundled payments, there is growing interest in identifying patients at high risk of early postoperative adverse events. The purpose of this study was to develop and validate a risk-stratification system for the occurrence of early adverse events among patients treated with open reduction and internal fixation (ORIF) for a closed fracture of the ankle. METHODS: Patients undergoing ORIF for a closed ankle fracture during the period of 2006 to 2017, as documented by the American College of Surgeons National Surgical Quality Improvement Program, were identified. For the 60% of patients randomly selected as the development cohort, multivariate Cox proportional hazards modeling was used to identify factors that were independently associated with the occurrence of adverse events (including events such as reoperation, surgical site infection, and pulmonary embolism). On the basis of these results, a nomogram analysis was used to generate a point-based risk-stratification system. To evaluate the validity of the point-based system, the system was applied to the remaining 40% of patients constituting the validation cohort and tested for its ability to predict adverse events. RESULTS: Of the 7,582 patients in the development cohort, 455 developed an adverse event (estimated adverse event risk of 6%). On the basis of Cox proportional-hazards regression, patients were assigned points for each of the following significant risk factors: +1 point for age of 40 to 59 years, +3 points for age of 60 to 79 years, +5 points for age of ≥80 years, +1 point for female sex, +2 points for chronic obstructive pulmonary disease (COPD), +2 points for insulin-dependent diabetes, +3 points for anemia, and +4 points for end-stage renal disease. The validation cohort included 5,263 patients. Among this second cohort, the risk-stratification system predicted the risk of early adverse events (p < 0.001; Harrell C = 0.697). CONCLUSIONS: The occurrence of early adverse events following ORIF for closed ankle fractures was associated with greater age, female sex, COPD, insulin-dependent diabetes, anemia, and end-stage renal disease. We present and validate a simple point-based risk-stratification system to predict the risk of early adverse events. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas do Tornozelo/terapia , Fixação Interna de Fraturas/métodos , Redução Aberta/métodos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Anemia/complicações , Fraturas do Tornozelo/complicações , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais
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