New anaesthetics & techniques for day case surgery.
A variety of drugs and techniques have been introduced into day surgery over recent years and, although the tide of development appears to have slowed, may of these will still be relatively new to many. Experience with the laryngeal mask continues to grow and it is now a firmly-established airway management tool in a wide variety of procedures. The cuffed oropharyngeal airway is an interesting recent arrival, but produces inferior airway control and is not a true alternative to the laryngeal mask. Desflurane and sevoflurane offer faster recovery through low solubility although the differences are small. Sevoflurane offers the interesting prospect of inhalation induction opening up the possibility of a radical change in technique and philosophy. In the intravenous arena remifentanil offers short-lived opioid side effects, but also short-lived analgesia, while propofol has a new, computer-assisted delivery system. In combination, these developments offer another opportunity for a dramatically altered technique. The long-awaited "depth of anaesthesia" monitor may have arrived, offering the possibility of more finely titrated anaesthesia with earlier (but not intraoperative!) awakening. Reliability is as yet uncertain and a simple technique with spontaneous ventilation may achieve similar results at substantially lower cost. The relative place of all these developments will take several years to become apparent and the future remains interesting.
Keele University. damsmith@btinternet.com
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D000556:Ambulatory Surgical Procedures; D000758:Anesthesia; D000777:Anesthetics; D006801:Humans
D000777:Anesthetics