No abstract available.
Ambulatory Surgical Procedures*

No abstract available.
Ambulatory Surgical Procedures* ; Korea*

No abstract available.
Ambulatory Surgical Procedures* ; Korea*

Background: Minimally invasive spine surgical techniques (MISST) are associated with less intraoperative blood loss, shorter duration of surgery, and less post-operative pain. In the last two decades, MISST have been performed on an outpatient basis in developed countries but it is still performed primarily on an inpatient basis in the Philippines. This study aims to determine the safety and effectiveness of performing MISST in an ambulatory surgical center in the Philippines.

Methods: A retrospective chart review of patients who underwent MISST in an ambulatory surgical center (ASC) in Manila, Philippines, from January 2014 to December 2018 was done. The different types of MISST were identified and analyzed as to patient demographic characteristics, anesthetic perioperative management, outcomes and complications.

Results: Out of 337 patients included in the review, 8 types of MISST were identified. The average patient age was 55.61 years. Majority (98.2%) of the patients were classified as American Society of Anesthesiologists (ASA) physical status I or II. All patients had a statistically significant (p < 0.05) reduction in pain scores. ASC length of stay varied based on the complexity of the procedure ranging from 2.1 to 12.9 hours. There was a 0.89% incidence of surgery-related complications. Majority (94.4%) of the patients were discharged to home. There was no mortality.

Conclusion: Even in a developing country, transitioning MISST from inpatient to the ambulatory setting can be performed with minimal complications and unplanned hospital admissions while still achieving significant pain reduction. The key elements include careful patient selection, close coordination between the anesthesia and spine surgical teams, and provision of multimodal analgesia.

BACKGROUND: Few studies have been conducted to evaluate the reliability of the various tools used to assess cognitive and psychomotor recovery after ambulatory anesthesia. Therefore, this study was conducted to compare the sensitivity and reliability of simple, standard tests used to measure postoperative cognitive and psychomotor functions. METHODS: Twenty-seven patients admitted for same day surgery were included in this prospective, randomized study. While in the preanesthetic unit, each patient was asked to perform three different standard psychometric tests, the digit symbol substitution test (DSST), digit span test (DST), and perceptual speed test (PST), to evaluate cognitive and psychomotor functions. The results were then used as baseline values that were subsequently compared to results obtained when patients repeated the tests at 15, 30 and 60 min after extubation. In addition, the observer's assessment of alertness and sedation was evaluated. RESULTS: The DSST scores were significantly lower than the baseline scores at 15 and 30 min after extubation, with a performance ratio of 64.9 and 89.2, respectively (P < 0.05). The DST scores had returned to preanesthetic levels at 30 min post-anesthesia and the PST scores were found to be significantly higher than the baseline scores at 30 and 60 min post-anesthesia. CONCLUSIONS: DSST is a more sensitive indicator of residual drug effect following anesthesia than the other tests evaluated in this study. In addition, a learning effect was obvious when the PST was administered.
Ambulatory Surgical Procedures ; Anesthesia ; Humans ; Learning ; Prospective Studies ; Psychometrics

One of the most significant changes in surgical practice during the past two decades has been the growth of ambulatory surgery. This change is owing to the increased popularity of minimally invasive surgical techniques and the improvement of various anesthetic techniques. Therefore, implementation of perioperative patient care paradigm that reduces the time to discharge home and resumption of activities of daily life after a wide variety of surgical procedures is required.
Ambulatory Surgical Procedures* ; Humans ; Patient Care ; Perioperative Care

BACKGROUND: We evaluated all ambulatory surgeries conducted at our center using several factors (the utility rate and the number of ambulatory surgery, unanticipated admission and its reasons) in order to improve the performance of our facility. We hope that this data could be an indicator of ambulatory surgeries in Korea, which will help strengthen the basis for its development. METHODS: We investigated this study by utilizing the retrospective methods. Data were obtained from hospital records over a period of 5 years (January 2006 to December 2010) for patients who underwent day surgeries at our Day Surgery Center (DSC). RESULTS: The utility rate of ambulatory surgery was 20.38%, 20.91%, 17.03%, 16.73% and 17.70% from 2006 to 2010 each year. The total number of ambulatory surgeries performed in our DSC from 2006 to 2010 was 6875, 7168, 7423, 7417 and 7798 for each year. The unanticipated admission rate were 19 patients (0.57%), 30 patients (0.93%), 20 patients (0.62%), 46 patients (1.26%) and 48 patients (1.25%), respectively. The major causes of admission were due to surgeon request and wish of patients. CONCLUSIONS: In the review of our DSC, although the number of ambulatory cases have been increased from 6875 to 7798, the trend of the utility rate of ambulatory surgery is slightly downward from 20.38% to 17.70% for the recent 5 years. All of the unanticipated admission rate per year was below 1.5% and most of the reasons of the unanticipated admission after ambulatory surgery were non-medical.
Ambulatory Surgical Procedures ; Hospital Records ; Humans ; Korea ; Retrospective Studies

Background: In an effort to prevent and address perioperative hypoxemia, it has become customary to provide supplemental oxygen to all surgical patients. Recently, the value of such a practice has been questioned. This study was designed to determine the incidence as well as the potential risk factors associated with perioperative hypoxemia. Methods: During a 9 - week period, 84 ASA I-II patients who underwent ambulatory surgical procedures under spinal anesthesia were observed. Arterial oxygen saturation (SpO2) was monitored using a pulse oximeter prior to induction of anesthesia, during operation and until the patient was discharged from the recovery room. Patients breathed room air during the entire perioperative course unless dyspnea and/or desaturation occurred. Descriptive statistics was used to examine differences in oxygen saturations before, during, and after surgery. The association between each of the potential risk factors and the number of patients requiring supplemental oxygen was analyzed using Fisher's exact test (for attribute data e.g. level of sensory block) and the Wilcoxon's rank sum test for continuous data (e.g. age, smoking in pack years) to calculate the probability that the proportions did not differ. A/>< 0.05 was considered statistically significant. Results: The incidence of preoperative, intra-operative and postoperative hypoxemia was 0 percent, 0 percent and 1.14 percent respectively while the need for supplemental oxygen was 2.27 percent intra-operatively and 2.27 percent postoperatively. Statistical analysis revealed that the level of block and body mass index were significant factors (P < 0.05) influencing the need for oxygen support. The need for supplemental oxygen was not associated with age, smoking history, surgical position, sedation level and Visual Analog Scale score. Conclusion: Results suggest that seemingly healthy patients who undergo lower abdominal, urologic, gynecologic or lower extremity surgical procedures under spinal anesthesia are at a low risk for hypoxemia. Pulse oximetry as part of routine monitoring may obviate the need for supplemental oxygen in this patient population. (Author)
Human ; ANESTHESIA ; ANOXEMIA ; OXIMETRY ; ANESTHESIA, SPINAL ; AMBULATORY SURGICAL PROCEDURES

OBJECTIVE: To evaluate the advantages and clinical value regarding the ambulatory surgery for thyroid.
 METHODS: A total of 66 patients (including 16 cases of differentiated thyroid cancer, 50 cases of benign thyroid tumors) from June 2014 to April 2015 in Center for Ambulatory Surgery of Xiangya Hospital were enrolled for this study and served as an exprimental group. All patients met pre-established ambulatory surgery criteria for thyroid. According to medical records, 133 patients with similar conditions to the experimental group were chosen as a control group. All of operations in two groups were completed by the same doctors. The time of operation, amount of bleeding during operation, drainage after the operation, operation method, resection range, histological features, surgical complications, average days of hospitalization, average hospitalization cost, the rate of re-admission and the satisfaction of patients were compared between the 2 groups. 
 RESULTS: Time of operation and amount of bleeding during operation were not significantly different between the 2 groups (P>0.05). In terms of drainage after operation and resection range, there were obvious differences between the 2 groups (P<0.05). The resection range and the amounts of drainage in the experimental group were less than those in the control group. More patients in the experimental group chose endoscopic thyroid surgery compared with those in the control group (P<0.05). The rate of surgical complications and re-admission was not different (P>0.05), but average days of hospitalization and average hospitalization cost were less in the experimental group (P<0.05). Patients were satisfied with ambulatory thyroid surgery (P<0.05).
 CONCLUSION Under certain criteria, ambulatory surgery for thyroid is a new operation method, which is safe, high-efficient, convenient, economy and time-efficient. It can decrease average days of hospitalization and average hospitalization cost obviously, and provide a reasonable choice for certain patients. The selection of endoscopic thyroid surgery was not conflict with selection of ambulatory thyroid surgery.
Ambulatory Surgical Procedures ; Drainage ; Endoscopy ; Hospitalization ; Humans ; Thyroid Neoplasms

BACKGROUND: Surgical procedures carried out under local anesthesia are associated with patient discomfort and apprehension. The purpose of this study is to compare propofol and midazolam with regard to their suitability for the patient controlled sedation (PCS) technique during local anesthesia. METHODS: Forty unpremedicated, ASA physical status I day surgery patients undergoing elective minor surgery were randomly divided into two equal groups of patients who self-administered either propofol or midazolam intraoperatively. All patients initially received 0.5 g.kg-1 fentanyl. The bolus dose was either 20 mg (2 ml over 25 sec) of self-administered propofol or 0.5 mg (2 ml over 25 sec) of midazolam and lock-out period was 1 min. RESULTS: The onset of sedation following propofol was significantly faster than midazolam (p<0.05) and demands of propofol was significantly less than midazolam (p<0.05). There were no significant differences for postoperative recovery, sedation and comfort scale. CONCLUSIONS: Propofol was judged the more suitable agent for PCS than midazolam, because of its more rapid onset of sedation and less demands of drug.
Ambulatory Surgical Procedures ; Anesthesia, Local* ; Anesthetics ; Fentanyl ; Humans ; Midazolam* ; Propofol* ; Surgical Procedures, Minor