By Michael Lavan R.N., Judy Swanson R.N., Andrea Ferrara M.D. (auth.), H. Randolph Bailey M.D., Michael J. Snyder M.D. (eds.)
Ambulatory Anorectal Surgery is a ordinary reference on all facets of office-based anorectal surgical procedure for training common surgeons and surgeons in education. Well-illustrated, this useful handbook indicates step by step techniques for: - Hemorroidectomy - fix of anal fissures - upkeep of Fistula in-ano - Colonoscopy - Pilondial cyst. The textual content contains ancillary concerns of ambulatory surgical procedure with well timed chapters on set-up of the power, anesthesic issues, number of sufferers, pre-op and post-op administration, nursing points, and coding and billing. A needs to for all normal surgeons.
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Extra resources for Ambulatory Anorectal Surgery
This is economical, because the high concentration required at the start of the procedure replaces the cost of propofo\. In the maintenance phase, less sevoflurane is required because the desired alveolar concentration has already been reached in the induction phase. Additionally, sevoflurane provides ideal conditions for intubation and precludes the need for muscle relaxants. Similarly, it provides good conditions for placement of the LMA. Another advantage of sevoflurane is in patients who are very frightened of needles.
Sevoflurane, initially suspect for its nephrotoxicity, fell out of favor until recently, and it is now beginning to gain in popularity for outpatient surgery. Choice of Narcotics Fentanyl has stood the test of time and is the most commonly used narcotic in outpatient anesthesia. It is important to administer fentanyl 2 to 5 minutes before the propofol so that the dose of propofol can be minimized and the maximal analgesic effect will be present during surgical and anesthesia stimulation. 0 f-Lglkg is given at the beginning of the anesthetic to avoid a delay in awakening.
Telephone interviews are usually adequate for the majority of the patients, but for patients with a more complicated medical history, a personal visit before surgery should be scheduled. The preoperative screening telephone interview and/or onsite visit should be arranged far enough in advance of surgery to allow time for additional laboratory test- ing or consultations. Members of the nursing staff complete the preoperative questionnaire, which contains pertinent questions on the different organ systems and the social history.