Anesthetic Considerations for Outpatient Surgery

Introduction

The outpatient surgery concept is in trend nowadays. Patients want surgery to be quick and satisfactory. The surgery has been adjusted to today's needs. The evolving time has developed the concept of outpatient surgery, which is used in many surgeries. And ease the patient and his family with low investment in time and money.

What Is Outpatient Surgery?

Outpatient surgery is also called ambulatory surgery or daycare surgery. The surgery that does not require any overnight stay in the hospital is called outpatient surgery. The term "outpatient surgery" is expressed as admitting the patient for surgery and discharging the patient after surgery on the same day. This concept of in-a-day surgery and discharge of the patient has benefitted the patient by consuming less time and money with better convenience and approach.

Where Are These Surgeries Performed?

These outpatient surgeries can be performed in the areas equipped with the surgery facility. It can be a doctor's office, hospital center, satellite setup, or small healthcare center equipped with the surgical needs and staff required for surgery and care.

What Are the Types of Anesthesia for Outpatient Surgery?

The anesthesia used in these types of surgery is for a short period. So the patient can leave the surgical center and go home quickly. There are four types of anesthesia used:

• General Anesthesia - This type of anesthesia is given through a mask or injected into the body intravenously. General anesthesia causes the patient to go to sleep or become unconscious during surgery. They are typically used in hip or knee surgery.

• Regional Anesthesia - These are given through injection. Or sometimes, attached with a catheter, usually at the spinal area in cases of childbirth. It is used to anesthetize the site in the body's periphery like a hand, shoulder, leg, and foot. Regional anesthesia numbs the body part and remains the patient awake. The patient will not feel the pain in the area while being conscious.

• Monitored Anesthesia Care (IV-Intravenous Sedation) - The medication is given before surgery, probably intravenously (injection into veins), which will cause sleep in the patient. Not all the patients will sleep; some remain awake and can even talk. Different bodies react differently to this monitored anesthesia care. It is a low-dose anesthesia technique with minimum damage to the body and is usually used in colonoscopies (endoscopy examination of the intestine).

• Local Anesthesia - Local anesthesia is given by injection. It numbs the small area as much as required for minor surgery. It is usually used in minor surgeries and biopsies. The patient remains awake and cannot feel the pain over the surgical site. The surgeries performed under local anesthesia include eye surgery, warts removal, fixing broken bones, and surgical dentistry.

What is Patient Selection in Outpatient Surgery?

The doctor selects the patient for outpatient surgery. The selection of the patient is one of the main steps before surgery and anesthesia. Patient selection is made to see if the patient can go for outpatient surgery or require medical attention for postoperative recovery. The points to be kept in mind for patient selection are:

• The patient should not be dealing with chronic unstable diseases like uncontrolled diabetes or heart disease.

• The patient should be able to resume regular body functions after surgery.

• The patient should have low complication chances after surgery.

• The patient should have a guardian while going for surgery and after 24 hours of surgery.

• The patient should be near medical centers till the time of recovery.

• The patient home environment should be suitable for recovery.

What Are the Anesthetic Considerations for Outpatient Surgery?

The doctor should examine the patient after selecting them. Some considerations are:

• The patient's medical history and family history should be taken beforehand. Cases with malignant hyperthermia can be treated likewise.

• The patient's anesthesia history is also noted so that any anesthesia-related problem can be inspected.

• Examining the risk for postoperative nausea and vomiting in patients is the most common complication.

• An airway assessment should be done to predict any difficulty in intubation.

• The elderly patient should be examined preoperatively to determine recovery after surgery.

• The risk for postoperative complications is high for obstructive sleep apnea patients, so postoperative monitoring and care increase in these patients.

What Anesthesia Is Used in Outpatient Surgery?

Commonly used anesthetics are:

• Midazolam.

• Fentanyl.

• Propofol.

• Volatile inhalation agents (Sevoflurane).

What Happens When a Patient Arrives for Outpatient Surgery?

The patient arrives at the center 1 to 2 hours before surgery. Before the surgery starts, the following procedures are done.

• The patient preoperative checkup is done.

• The patient is not allowed to eat or drink before the surgery.

• The patient is made to lie on the operating theater bed after preoperative evaluation.

• Anesthesia is given after the blood pressure and other parameters are checked.

• Before surgery, the anesthesia is given, and surgery proceeds.

What Happens After Surgery?

• The patient is taken care of by the other staff members after surgery is done.

• The staff shifts the patient to the recovery room, where the patient is fully awake from sedation.

• In the recovery room, complications are noted, like vomiting, chills, or high blood pressure.

• The patient waking from sedation can take 1 to 3 hours.

• The doctor monitor’s the patient's vital signs( temperature, blood pressure, breathing rate).

• After vital signs, the doctor notices other parameters like oral tolerance to food and the patient's walking.

• After realizing the patient's oral tolerance, empty bladders, and walking, the doctor sends the patient home.

• But before going home, medications and instructions are given, along with regular checkups.

What Are the Indications of Outpatient Surgery?

Many surgeries are done as outpatient surgery. A few of them are mentioned below:

• Cataract Surgery - The surgery for eye vision impairment and blindness. The surgery is very commonly done.

• Sclerotherapy - The surgery done to treat the varicose vein and spider veins. Varicose veins are the legs' twisted, swollen, and raised blood vessels. Spider veins are visible and swollen blood vessels on the legs, chest, and face.

• Septoplasty - It is a procedure to fix a deviated nasal septum.

• Tonsillectomy - It is a procedure for completely removing the palatine tonsils from the back of the throat.

• Hip and Knee Arthropathy - It is a joint replacement or realignment procedure.

• Rotator Cuff Repair - A rotator cuff is a group of muscles and tendons that connect the upper arm to the shoulder. Any injury to the rotator cuff requires repair.

• Myomectomy - It is a minimally invasive, safe, and effective procedure for the removal of fibroids.

• Vasectomy - The procedure involves cutting and sealing the vas deferens to prevent sperm from entering the urethra.

• Laparoscopic Cholecystectomy - The surgical removal of the gallbladder due to gallstones.

Conclusion:

Outpatient surgery is a type of surgery performed and discharges the patient in a day to go home, and it utilizes general, regional, and local anesthesia and monitored anesthesia care. Many surgeries are performed on outpatients. Some are cataract surgery, laparoscopic surgery, hip and knee arthropathy, and sclerotherapy. This outpatient surgery minimizes the patient’s long hospital stay and promotes speedy recovery.