[Anesthesia for surgery in ambulatory patients: organizational aspects of the hospital physician].
At first sight it seems impossible to put into practice the 1992 resolution of the German Federal Council recommending increased frequency of hospital based operative care for ambulatory patients and the duty to do so under full financial coverage. A detailed analysis of the current situation suggests that this may be possible even today--with some reservations regarding the infrastructure of the hospitals. Selection and preparation of the patient is a process in which the anaesthesiologist must play an important role. Delegation of this duty to the surgeon or the general practitioner is not permitted. The anaesthesiologist must have sufficient time, prior to the procedure, to meet the patient; meeting the patient for the first time a few minutes before induction of anaesthesia is unacceptable. Even if one concedes freedom of methods, one drug and one procedure should be avoided while caring for surgical ambulatory patients: this drug is succinylcholine, because of life-threatening hyperkaliaemia in children with occult myopathy and severe and frequent myalgia especially in ambulatory patients. The procedure not suitable in ambulatory patients is subarachnoidal analgesia--due to an unacceptably high percentage of headaches in young ambulatory patients. The postoperative care and observation must be delegated to especially qualified persons only--and these persons should not be distracted by duties outside the recovery area. The anaesthetist must--in addition--be available at all times without delay. Pain, nausea and emesis molest the ambulatory patient during the postoperative course to a particular extent. The anaesthesiologist must take care of these complaints--even if the patient is discharged.(ABSTRACT TRUNCATED AT 250 WORDS)
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Klinik für Anaesthesie und Operative Intensivmedizin, Städtisches Krankenhaus Heilbronn, Ruprecht-Karls-Universität Heidelberg.
D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000768:Anesthesia, General / Q000191:economics*; D003363:Cost Control / Q000639:trends; D005858:Germany; D006801:Humans; D008505:Medical Staff, Hospital / Q000191:economics*; D010817:Physician-Patient Relations; D011182:Postoperative Care / Q000191:economics; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011785:Quality Assurance, Health Care / Q000191:economics; D012307:Risk Factors
Anästhesie für Operationen bei ambulanten Patienten: Organisatorische Aspekte des Krankenhausarztes.