Clinics in plastic surgery
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Ambulatory surgery is commonplace for a multitude of procedures and a wide range of patients. The types of procedures performed in the ambulatory setting are becoming more work-intensive, and patients with comorbidities make for a challenging environment. For a safe environment for surgery in ambulatory facilities, the complex task of patient selection is necessary. Until an algorithm is created that includes provider, procedure, facility, and patient comorbidites, clinicians must rely on general guidelines rather than precise recommendations.
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Most outpatient cosmetic procedures are now performed in surgeons' offices, with patients under local anesthesia and minimal intravenous sedation. Sedation at any level beyond minimal creates the risk of airway obstruction and ventilatory depression, which can result in irreversible brain injury or death within minutes. This article discusses appropriate patient and procedure selection, and outlines the personnel, equipment, and techniques necessary to avoid such outcomes.
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Ambulatory surgery centers (ASCs) are being asked to use a safe surgical checklist in 2012 and to report that it has been used in 2013. Checklists should focus on communication and safe surgery practices in each of 3 perioperative periods: (1) before administration of anesthesia, (2) before skin incision, and (3) the period of incision closure and before the patient leaves the operating room. This article reviews the origin of surgical checklists. It examines evidence that indicates that checklists decrease the incidence of human errors, mortality, and morbidity.
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Review
Management of postoperative nausea and vomiting in ambulatory surgery: the big little problem.
Identifying those patients with the highest risk leads to the greatest success in reducing postoperative nausea and vomiting by modifying the anesthetic plan to decrease baseline risk, and implementing the appropriate use of prophylaxis. The strategies that will be effective in the reduction of postdischarge nausea and vomiting are currently being studied.
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The safety, efficacy, and rapid recovery of conscious sedation/local anesthesia make this anesthetic technique useful in the ambulatory setting. The care of the sedated patient requires a team effort. ⋯ The current technique, using low-dose propofol, is described in detail. Using conscious sedation, the patient's level of consciousness is depressed, but respiratory drive and airway reflexes are maintained and anesthesia is provided by infiltration of local anesthetic.