1. Dr CHANDRASHEKARA.C.R
Consultant Anaesthesiologist
NOVA MEDICAL CENTERS,SAGAR HOSPITALS,
BANGALORE
2. Anaesthesia
Day careanaesthesia/ ambulatory anaesthesia/ Office
based anaesthesia
25 million surgeries per year -70 % ambulatory
surgeries,10% - children –IDEAL FOR DAY CARE
3. Development
Ether- Sevoflurane, Deflurane
Thiopentone- Propofol
Short acting muscle relaxants
Short acting yet potent analgesics
Open surgery to Laparoscopic surgery
Patient xx / Pain Abdomen
9. Procedure
ENT/Dental
OBG
D&E Myringotomies
D&C, Hysteroscopic Nasal and aural foreign body
D&C removal
Lap ovarian Adenotonsillectomy
cystectomy Mastoidecomy/tympanoplasty
Diagnostic lap Restoration
Others Extraction
10. NOT FOR DAY CARE
Active asthma/URTI/Difficult
Airway
CHF/IHD/Un controlled
HTN/Cardio myopathies
Uncontrolled DM
Morbid obesity
Haemorrhage/fluid shifts
?Procedures more than 90
minutes
Prematures
11. Our Success
Proper Selection of cases
Pre-operative assessment /Stabilisation .
Well planned anaesthetic techniques/ modified?
Management of post-operative pain, nausea and
vomiting
Discharge according to protocol
Extended Day care facility
12. PAC
Premedication-
H2 receptor antagonists ,antacids,
analgesics,Steroids,Chest physiotherapy, Nebulisation
To continue other medications
Phy/Cardio/Endocrinology opinion
13. Anaesthesia
Pre op counseling/
Premedication
GA – LMA/ETT
Propofol/Short acting
Relaxants
OPIOD/Non opiod based
analgesia
Local anaesthetics/ Nerve
blocks/ Epidurals
15. Pain-Multimodal approach
Targeting different
levels
Optimal pain relief
with minimal side
effect
Combination of
analgesics drugs and
techniques enhance
the analgesic level
16. Pain management
shorter discharge times, lower pain scores, and a lower incidence of nausea and
vomiting, compared with traditional opiate-based anesthetic techniques
17. Pain
IV Fentanyl-2 mic gms/kg bolus/1mic gms infusion
IV Paracetamol 20 mg/kg – upto 4 gms/day
?IV Diclofenac upto 150 mg/ day
IV Ketorolac[0.8 mg/kg, max 60 mg- low pain score,
decreased opiods
Extended day care- Morphine, Pethidine
18. PONV
PONV distressing complication of ambulatory
anesthesia
Delayed discharge and unanticipated admissions
The role of Nitrous oxide in contributing to PONV is
unclear
Propofol- less nausea and vomiting than other
induction drugs with its rapid recovery profile
Neostigmine be associated with an increased
incidence of PONV