| Popis: |
The spreading of the cost-benefit attitude is a considerable help in the progress of the one day surgery. The patient selection, the preoperative patient preparations and the preoperative examination has done in the anaestesiologic ambulance. Aims of ambulatory anaesthesia are to achieve sedation, hypnosis, analgesia, amnesia and muscle relaxation during the operation, to preserve preoperative mental and physiologic state, analgesia and to make early postoperative nourishing possible. Besides personnel and equipment of anaesthesia and reanimation, monitoring of circulation, respiration and neuromuscular transmission is needed. Anaesthetic methods: local, regional and general anaesthesia or sedation. Ways of general anaesthesia are intravenous, inhalation or combined. Intravenous anaesthetic drugs (barbiturates, ketamine, etomidate, midazolam, propofol and eltanolon) can be used in monotherapy or in combination with each other or opioids (morphine, alfentanil, fentanyl, sufentanil, remifentanil). Among inhalatic agents N2O isoflurane, desflurane, sevoflurane are advisable. Recommended non depolarising muscle relaxants are the short-acting atracurium, mivacurium, vecuronium and rocuronium. Methods for loco-regional anaesthesia are infiltration, peripheral nerve blockade, epidural and intradural anaesthesia which can be used with additional vigil sedation. Blockades with local analgetics, intraoperative opioids, non-steroid anti-inflammatory drugs, sedatives, pre-emptiv analgesia and patient controlled analgesia can be used for postoperative pain relief. Besides the patient and intervention type selection the adequate perioperative anaesthesiologic work and the prudent specifications of leaving conditions is the most important terms of the safety of one-day surgery and anaesthesia. |
