Patient selection in ambulatory anesthesia — An evidence-based review: part I

  • Gregory L. Bryson
  • Frances Chung
  • Barry A. Finegan
  • Zeev Friedman
  • Donald R. Miller
  • Janet van Vlymen
  • Robin G. Cox
  • Marie -Josée Crowe
  • John Fuller
  • Cynthia Henderson
  • Canadian Ambulatory Anesthesia Research and Education (CAARE) Group
General Anesthesia

Abstract

Purpose

To identify and characterize the evidence supporting decisions made in the care of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: the elderly heart transplantation, hyper-reactive airway disease, coronary artery disease, and obstructive sleep apnea.

Source

A structured search of MEDLINE ( 1966–2003) was performed using keywords for ambulatory surgery and patient condition. Selected articles were assigned a level of evidence using Centre for Evidence Based Medicine (CEBM) criteria. Recommendations were also graded using CEBM criteria.

Principal findings

The elderly may safely undergo ambulatory surgery but are at increased risk for hemodynamic variation in the operating room. The heart transplant recipient is at increased risk of coronary artery disease and renal insufficiency and should undergo careful preoperative evaluation. The patient with reactive airway disease is at increased risk of minor respiratory complications and should be encouraged to quit smoking. The patient with coronary artery disease and recent myocardial infarction may undergo ambulatory surgery without stress testing if functional capacity is adequate. The patient with obstructive sleep apnea is at increased risk of difficult tracheal intubation but the likelihood of airway obstruction and apnea following ambulatory surgery is unknown.

Conclusion

Ambulatory anesthesia is infrequently associated with adverse outcomes, however, knowledge regarding specific patient conditions is of generally low quality. Few prospective trials are available to guide management decisions.

La sélection des patients en anesthésie ambulatoire — Une revue factuelle : partie I

Résumé

Objectif

Identifier et caractériser la preuve à l’appui des décisions prises sur les soins à donner aux patients qui présentent des pathologies médicales ciblées et qui subissent une anesthésie en chirurgie ambulatoire. Les situations sélectionnées dans cette revue comprennent : la vieillesse, la transplantation cardiaque, l’affection respiratoire hyper-réactionnelle, la coronaropathie et l’apnée obstructive du sommeil.

Source

Une recherche structurée dans MEDLINE (1966–2003) a été réalisée selon les mots dés pour la chirurgie ambulatoire et l’état du patient. Les articles choisis ont été cotés selon le niveau de preuve des critères du Centre for Evidence Based Medicine (CEBM). Les recommandations ont aussi été graduées selon les critères du CEBM.

Constatations principales

Les personnes âgées peuvent subir une opération ambulatoire en toute sécurité, mais sont plus à risque de variation hémodynamique en salle d’opération. Les greffés cardiaques sont plus à risque de coronaropathie et d’insuffisance rénale et doivent avoir une évaluation préopératoire minutieuse. Les cas d’affection respiratoire réactionnelle sont plus à risque de complications respiratoires mineures et doivent être encouragés à cesser de fumer. Le patient atteint de coronaropathie, victime récente d’infarctus myocardique, peut être vu en chirurgie ambulatoire sans épreuve d’effort si la capacité fonctionnelle est adéquate. En cas d’apnée obstructive du sommeil, il y a plus de risque de difficulté d’intubation trachéale, mais la possibilité d’obstruction des voies aériennes et d’apnée à la suite d’une opération ambulatoire n’est pas connue.

Conclusion

Lanesthésie ambulatoire n’est pas souvent associée à des complications, même si la connaissance de pathologies spécifiques est peu développée en général. Il existe peu d’études prospectives permettant de guider les décisions thérapeutiques.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Gregory L. Bryson
    • 1
  • Frances Chung
    • 2
  • Barry A. Finegan
    • 3
  • Zeev Friedman
    • 4
  • Donald R. Miller
    • 1
  • Janet van Vlymen
    • 5
  • Robin G. Cox
    • 6
  • Marie -Josée Crowe
    • 7
  • John Fuller
    • 8
  • Cynthia Henderson
    • 9
  • Canadian Ambulatory Anesthesia Research and Education (CAARE) Group
  1. 1.Department of AnesthesiologyThe Ottawa HospitalOttawaCanada
  2. 2.Department of AnesthesiaToronto Western HospitalToronto
  3. 3.Department of Anesthesiology and Pain MedicineUniversity of AlbertaEdmonton
  4. 4.Department of AnesthesiaMount Sinai HospitalToronto
  5. 5.Department of AnesthesiologyKingston General HospitalKingston
  6. 6.Department of AnesthesiaAlberta Children’s HospitalCalgary
  7. 7.Département d’AnesthésiologieHôpital Ste-JustineMontréal
  8. 8.Department of Anesthesia and Perioperative CareSt. Joseph’s Health CareLondon
  9. 9.Department of AnesthesiaVancouver General HospitalVancouverCanada

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