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Ambulatory Surgery: Advantages and Challenges Essay

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Updated: Jun 2nd, 2021

The Emergence, Advantages, and Challenges of AS

The practice of AS allows performing operations outside the hospital settings, which helps to save time and costs. The concept of AS developed at the beginning of the 1990s with the aim of promoting early hospital discharge and fast recovery (Jafra & Mitra, 2018). The major advantages of AS are the considerable reduction of care cost and easier resumption of daily activities by patients. However, there are also serious drawbacks, such as poorly controlled pain and decreased quality of life (Jafra & Mitra, 2018). It is necessary to implement a proactive approach when managing postoperative pain to increase patient satisfaction and comfort.

Assessing Patients before Admission

Prior to admitting patients to an AS unit, it is necessary to perform preoperative assessment the benefits of which include the reduction of surgery cancellations and enhancing the patient’s condition. Four types of factors need to be considered before admission: surgical, social, and medical (Lee, 2017). Surgical aspects involve the absence of complications’ risk, the creation of a surgery plan, and the experience of a physician.

Social considerations include patients’ consent, the guarantee of easy access after discharge, the proximity of one-hour driving distance to emergency care in case of acute pain, and positive environment at home (Lee, 2017). Medical aspects presuppose a satisfactory BMI and the absence of unstable medical conditions (Lee, 2017). There are also anesthetic and special considerations, such as old age, sleep apnea, or difficult airway intubation.

Anesthetic Techniques Used in the Ambulatory Setting

Choosing the right anesthetic agent for AS is crucial since patient safety depends on it. Due to the carefully selected anesthetic technique, patients are able to recover faster and resume their daily chores without having to remain limited in their movements. Recent growth of short-acting and minimally invasive anesthetics has led to an increase in AS services (Lee, 2017). To decide on the safest and most successful anesthetic agent, the physician should pay attention to various factors pertaining to the patient.

Depending on the patient’s preference, physical state and age, the duration of the drug’s effect, and the degree of care required after the operation, general, regional, or monitored anesthesia may be selected. General anesthesia is the most typical option due to being inexpensive, safe, familiar to the majority of specialists, and easy to recuperate from (Lee, 2017). The introduction of new anesthetics, such as desflurane, propofol, or sevoflurane, has made it possible to gain patients’ faster awakening. Additionally, general anesthesia fosters the process of meeting “postanesthesia care unit (PACU) discharge criteria” (Lee, 2017, p. 400).

Regional anesthesia allows reaching the peripheral nerve blockade and neuraxial blockade. While this kind of anesthesia results in fewer side effects, it also takes a longer time to take effect (Lee, 2017). Monitored anesthesia care (MAC) involves the use of an intravenous injection of analgesic and sedative drugs. MAC leads to the reduction of recovery time and a rise in patient satisfaction (Lee, 2017). To ensure proper intraoperative care related to patient advocacy, safety, and infection prevention techniques, anesthesiologists have to select the kind of anesthetic rather cautiously by considering the patient’s and operation’s characteristics.

Post-AS Interventions

The most typical post-AS procedures include those directed at pain and vomiting management. Postoperative pain-relieving techniques involve analgesic administration and regional nerve block (Lee, 2017). What concerns nausea and vomiting, these instances prevail in about 30% of patients (Lee, 2017). To mitigate the risk, it is recommended to minimize narcotic analgesics and fluid therapy in the preoperative period. Also, it is helpful to administer antiemetic drugs from a group that is dissimilar to the initial prophylactic group.

References

Jafra, A., & Mitra, S. (2018). Pain relief after ambulatory surgery: Progress over the last decade. Saudi Journal of Anesthesia, 12(4), 618-625.

Lee, J. H. (2017). Anesthesia for ambulatory surgery. Korean Journal of Anesthesiology, 70(4), 398-406.

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