Clinical Ambulatory Anesthesia

195 Pages·2010·1.95 MB·English

by  Johan Raeder

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Clinical Ambulatory
Anesthesia

Clinical Ambulatory
Anesthesia
Johan Raeder
DirectorofAmbulatoryAnesthesia,OsloUniversityHospitalandProfessorofAnesthesiology,UniversityofOslo,Norway
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore,
São Paulo, Delhi, Dubai, Tokyo
Cambridge University Press
The Edinburgh Building, Cambridge CB2 8RU, UK
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521737814
© J. Raeder 2010
This publication is in copyright. Subject to statutory exception and to the
provision of relevant collective licensing agreements, no reproduction of any part
may take place without the written permission of Cambridge University Press.
First published in print format 2010
ISBN-13 978-0-511-74466-2 eBook (EBL)
ISBN-13 978-0-521-73781-4 Paperback
Cambridge University Press has no responsibility for the persistence or accuracy
of urls for external or third-party internet websites referred to in this publication,
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Every e(cid:2)ort has been made in preparing this book to provide accurate and up-to-
date information which is in accord with accepted standards and practice at the
time of publication. Although case histories are drawn from actual cases, every
e(cid:2)ort has been made to disguise the identities of the individuals involved.
Nevertheless, the authors, editors and publishers can make no warranties that the
information contained herein is totally free from error, not least because clinical
standards are constantly changing through research and regulation. The authors,
editors and publishers therefore disclaim all liability for direct or consequential
damages resulting from the use of material contained in this book. Readers are
strongly advised to pay careful attention to information provided by the
manufacturer of any drugs or equipment that they plan to use.
Contents
Preface pagevii
1 Backgroundtoambulatorysurgery 7 Practicalrecipes,fromstart(pre-op)
andanesthesia 1 toend(discharge) 152
2 Organizationofambulatory 8 Somecontroversiesinambulatory
surgeryandanesthesia 7 anesthesia 164
3 Procedureandpatientselection, 9 Successcriteriaandfutureof
pre-admittancepreparation 15 ambulatoryanesthesia 176
4 Pharmacology 38
5 Anesthetictechniquesfor
ambulatorysurgery 68 Index 180
6 Postoperativecare 106
v

Preface
Myambitionwiththisbookistoprovideaguidetoappliedandpracticalwaysofachieving
ambulatory anesthesia. Ambulatory anesthesia incorporates most anesthetic topics and
knowledge, but the focus is shifted somewhat from looking solely at what happens in the
operatingroomtoviewingthecompleteperioperativeperiod.Althoughsafetyandqualityin
the operating room remain major goals, the ambulatory anesthetist should always plan to
optimizethepostoperativeperiod.Thisisnotanexhaustivetextbook,butratheraselection
of topics that I think are important in this context for the anesthesiologist. I have also
incorporated brief surveys on important aspects of organization, unit setup, and quality
assurance,astheanesthesiologistoftenwillbetheperioperativephysicianinvolvedthrough-
out the patient’s treatment, from start to finish. Discussions of and references to basic
anesthesiologicalknowledgeshouldbesoughtelsewhere,butIhopetobringforwardsome
issuesrelatedto,andevidencefor,thepragmaticandgoodpracticeofambulatoryanesthesia.
However,inmanycasesthereisnofirmevidenceorthereisconflictingevidenceregarding
differentaspectsofthecase.Asanesthetistsmustmakedecisionsunderthesecircumstances,
Ihavetriedtoguideyoubasedonmorethan25yearsofclinicalpracticeinmostkindsof
ambulatoryandoffice-basedpractice.Ihavealsotriedtoincorporateknowledge fromour
ownclinicalresearchaswellastheresearchandteachingbymymanygoodfriendsworking
on the international ambulatory anesthesia scene. Special thanks are due to my two good
friends Professor Kari Korttila, who introduced me to the international organization of
ambulatoryanesthesia,andProfessorPaulF.White,whohasnourishedmeovermanyyears
withhisvastpersonalknowledge.Ialsowishtoexpressmygratitudetoeveryonewhohas
workedwithmeovertheyears,foralltheirunceasinginspirationandgoodideas.Further,I
gratefullyacknowledgemysupportivefamilyandCambridgeUniversityPressforproviding
mewithallhelpandthisgreatopportunity.
JohanRaeder
Oslo
vii