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Index

ACE inhibitors, 26acetaminophen, see paracetamolacupressure, anti-emetic effect,

143acute drugs, 64–5adenoidectomy, 161adrenaline, 64α-2-chloroprocaine, 74, 81age impact on patient selection,

18–20agitation, postoperative, 147airway disease, 20–1ASA III pulmonary/airwaydisease patients, 91

preoperative information, 31alcohol abuse, 25–6anesthesia and, 95–6

alfentanil, 51, 59, see alsoopioids

allergies, 29anesthesia and, 98preoperative information, 32

α2-adrenergic receptoragonists, 121–2

ambulatory surgerydefinitions, 1–2economy, 5future aspects, 178–9history, 2–3organization, 7–10procedures, 16quality, 4–5reasons for, 3safety, 3–4staff satisfaction, 6success criteria, 176–8

ambulatory unitas satellite of inpatienthospital, 9

documentation, 13–14equipment, 12freestanding hospital, 9–10freestanding office-based, 10freestanding unit insideinpatient hospital, 9

integration into inpatienthospital, 8

optimal size, 10–11personnel, 12–13physical requirements, 11–12

analgesia see also postoperativepain; specific analgesics

multimodal, 109nonopioid analgesics, 107,109–24

opioids, 109pre-emptive, 106–7, 126

anesthesia see also generalanesthesia; localanesthesia; regionalanesthesia

acute disease and, 96alcohol/drug abuse and, 95–6allergy and, 98ASA III pulmonary/airwaydisease patients, 91

breastfeeding patients, 96cardiovascular diseasepatients, 91–3

children, 88–90, 159–61choice of technique, 87–8diabetic patients, 95elderly patients, 90–1epileptic patients, 97–8future aspects, 178–9history, 12–13information for patient, 33–4kidney disease and, 97liver disease and, 97neurologic diseases and, 97obese patients, 93–5pregnant patients, 96preoperative information, 32problems with, 29, 98psychiatric patients, 96rheumatic conditions, 97success criteria, 176–8thyroid disorders and, 97

anesthetic report, 14angina pectoris, 22anesthesia and, 92

angiotensin blockers, 26ankylosing spondylitis, see

Bechterew disease

anti-asthmatics, 26–7anticholinergics, 143anticoagulants, preoperative,

98–9anticoagulated patients, 23–4loco-regional techniquesand, 78

anti-emetic drugs, 140–1anticholinergics, 143antihistamines, 143ephedrine, 143glucocorticoids, 142–3metoclopramide, 141–2neuroleptics, 142NK1 inhibitors, 143serotonin antagonists, 142

antihistamines, 143antineuropathics, 120–1antiplatelet therapy, 23anxiety, postoperative, 147aortic insufficiency, 23

anesthesia and, 92arrhythmia, 23articaine, 74, 81ASA classification, 18asthma, 91anti-asthmatics, 26–7children, 19preoperative information, 31

atropine, 64AV block, 23awake patient during

procedure, 72

barbiturates, 58Bechterew disease, 28–9anesthesia, 97

bed rest, 5benzodiazepine antagonists, 64benzodiazepinessedation, 86side-effects, 50

beta-blockers, 27, 64, 166bispectral index (BIS), 87BIS monitoring, 169

body mass index (BMI), 24–5bodybuilders, 26

180

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bradycardia, 64breastfeeding patients, 28anesthesia, 96

bupivacaine, 80

calcium channel blockers, 120–1cannabinoids, 122–3cardiovascular disease, 91–3anesthesia and, 91–3

children, 18–19anesthesia, 88–90, 159–61asthma, 19ENT procedures, 160–1paracetamol use, 110–11runny nose, 19sedation, 88sleep apnea syndrome, 19target control infusionmodels, 56

2-chloroprocainecholesterol-lowering drugs, 27chronic obstructive pulmonary

disease (COPD), 91obese patients, 93

circulatory side-effects, 50cisatracurium, 71clearance, 39, 44clonidine, 80, 122codeine, 60–1cognitive dysfunction, 4anesthesia and, 96loco-regional techniquebenefits, 72

patient selection, 27complications see also

side-effectsinformation for patient, 33,34–5

context sensitive eliminationtime, 46

coronary infarction, 22anesthesia and, 92

cost-efficacy, 177COX inhibitors, 113–14cyclooxygenase (COX), 113–14

dental surgery, 162depth of anesthesia monitoring

(DAM), 168–70desflurane, 57, 69 see also

inhalational drugschildren, 90pharmacodynamics, 41–2

pharmacokinetics, 40–1dexamethasone, 116–18 see also

glucocorticoidsperoperative administration,126

side-effects, 118dexmedetomidine, 59, 73, 167sedation, 87

diabetes mellitus, 25anesthesia and, 95preoperative information, 31

diazepam, 58, 73discharge, 149–50criteria, 15–16, 149–9information for patient,149–50

post-discharge care, 150–1distribution volume, 38, 44documentation, 13–14droperidol, 80, 142drug abuse, 25–6

anesthesia and, 95–6bodybuilders, 26

drug metabolism, 39 see alsopharmacology

economy, 5cost-efficacy, 177loco-regional techniques, 73

education, 6effect-site target control infusion

(TCI) system, 53–4versus plasma TCI system, 55

elderly patients, 19–20anesthesia, 90–1

electrostimulation, anti-emeticeffect, 143

emergencies, 6, 11acute drugs, 64–5

emergency equipment, 12emergency surgery, 15endotracheal (ET) tube,

171, 172ENT procedures, children,

160–1ephedrine, 64, 143epidural anesthesia, 78–9epilepsy, 29anesthesia and, 97–8preoperative information, 31

epinephrine, 122equipment, 12loco-regional techniques, 74

esmolol, 64eye surgery, 162

facial mask, 170fast-tracking, 73fentanyl, 51, 59, 70 see also

opioidsinteractions, 43

foot surgery, 81–2

gabapentin, 120–1gastric tubes, 140gastro-oesophageal reflux

disease, obese patients, 93general anesthesia, 12–13, 88general, 68inhalational anesthesia, 68–9intravenous anesthesia,69–70

obese patients, 94–5glucocorticoids, 115–19analgesic action, 116–19anti-emetic effects, 142–3clinical actions, 116, 118effect mechanisms, 115molecular actions, 115–16peroperative administration,125–6

preoperative, 99side-effects, 118

glycopyrrolate, 62–3

heart block, 23heart failure, 23anesthesia and, 92

heart valve dysfunction, 23anesthesia and, 92

hepatic disease see liver diseasehospital-acquired infection, 4hyperalgesia, 60, 64, 70prevention, 106, 126

hypertension, 22anesthesia and, 91–2preoperative information, 31

hypnotics, 42, 58–9 see alsointravenous drugs

interactions, 50–2sedation, 87side-effects, 50

hypotension, 64

immobility, 5infants see newborn infants

Index

181






infectionas contraindication for loco-regional techniques, 78

preoperative information, 31respiratory infections, 20risk of, 4

information for patient, 32–5anesthesia plan, 33–4discharge, 149–50logistics, 34side-effects, 33, 34–5

inguinal hernia repair, 83inhalational anesthesia see also

inhalational drugsbenefits of, 167induction, 158–9, 168maintenance, 168recipes, 156–9versus intravenousanesthesia, 165

inhalational drugs, 56–7, 68–9,see also specific drugs

children, 160interactions with intravenousagents, 42–3

pharmacodynamics, 41–2pharmacokinetics, 39–41

inpatient hospitalambulatory programme asfraction of, 8

ambulatory unit as satellite, 9ambulatory unit integration, 8freestanding ambulatory unitwithin, 9

single ambulatory patientintegration, 7

insulin see diabetes mellitusintra-cardiac defibrillator

(ICD), 92–3intralipid, 65intravenous anesthesia see also

intravenous drugscontroversies, 164–7recipes, 152–9

intravenous drugs, 69–70 seealso hypnotics; opioids;specific drugs

interactions, 42–3, 50–2pharmacodynamics,46–50

pharmacokinetics, 43–6regional anesthesia, 83

intubation, 70–1, 171, 172

isoflurane, 57pharmacodynamics, 41–2pharmacokinetics, 40–1

joints, local anestheticinfusion, 74

keO, 47ketamine, 63–4, 166

children, 161postoperative painmanagement, 64, 119–20

ketorolac, 113–14kidney disease, 28anesthesia and, 97

laparoscopy, 161laryngeal mask airway (LMA),

70, 170–2levobupivacaine, 74lidocainepostoperative painmanagement, 120–1

transient neurologicsymptoms and, 79–80

liver disease, 28anesthesia and, 97

local anesthesia, 13, 71–3, 77, 88see also loco-regionaltechniques

definition, 71infusion into wounds orjoints, 74

postoperative painmanagement, 110

procedures, 76–7loco-regional techniques, 71,

83–4 see also localanesthesia; regionalanesthesia

acceptance by patient, 75acceptance by surgeon, 75block failure avoidance, 76contraindications, 78economy, 73elderly patients, 91equipment, 74local infiltration, 84new drugs, 74new techniques, 74–5obese patients, 94preoperative delayavoidance, 75–6

prolonged block avoidance,76

quality, 72–3safety, 72

magnesium, 123–4medicationsdrug history, 32patient selection and,26–7

membrane stabilizing drugs,120–1

methohexital, 58, 166methylnaltrexone, 143methylprednisolone, 116, 117

see also glucocorticoidsmetoclopramide, 141–2metoprolol, 64mexiletine, 120–1midazolam, 58, 73interactions, 43, 58

mitral insufficiency, 23anesthesia and, 92

mivacurium, 62, 71mobilization, 5monitored anesthesia care

(MAC), 71monitoringdepth of anesthesiamonitoring (DAM),168–70

equipment, 12sedation, 87

multimodal analgesia, 109myringotomy, 160

nalbuphine, 80naloxone, 143nausea, 72, see also

postoperative nausea andvomiting

physiology, 137neostigmine, 62–3, 71

postoperative painmanagement, 123

nerve blocks see neuromuscularblockers; peripheralblocks; regionalanesthesia

neuraxial blocks, 78–81neuroleptics, 142neurologic diseases, 29

anesthesia, 97

Index

182






neuromuscular blockers, 39,61–3, 70–1, 76, 159, 166,see also loco-regionaltechniques

recipe, 159reversal agents, 62–3

newborn infants, 18premature, 18–19

nicotine, postoperative painmanagement, 123

nitrous oxide, 57, 69 see alsoinhalational drugs

children, 89–90pharmacodynamics, 41–2pharmacokinetics, 40–1recipes, 154–5, 156supplementation, versusTIVA, 164

NK1 inhibitors, 143NMDA-receptor antagonists,

119–20nonopioid analgesics, 61, 107,

109–24 see also specificanalgesics

adjuvants, 122–4α2-adrenergic receptoragonists, 121–2

calcium channel blockers,120–1

clinical application, 124–6glucocorticoids, 115–19local anesthesia, 110NMDA-receptorantagonists, 119–20

nonsteroidal anti-inflammatory drugs(NSAIDs), 111–15

paracetamol, 110–11principles, 109

nonsteroidal anti-inflammatorydrugs (NSAIDs),111–15

preoperative administration,125

side-effects, 112–13,114–15

obesity, 24–5, 163anesthesia and, 93–5premedication and, 94

older patients see elderlypatients

ondansetron, 142

opioid antagonists, 64opioids, 42, 59–61, 70 see also

intravenous drugscombination with propofol,50–2

elderly patients, 91interactions, 50–2postoperative painmanagement, 109

recipes, 154–9sedation, 86–7side-effects, 49–50

oral contraceptives, 26organization, 7–10, see also

ambulatory unitorthopedic surgery, 162outpatient consultation, 1–2,

151oxycodone, 60

pacemaker, 23anesthesia and, 92–3

pain see postoperative painparacetamol, 110–11preoperative administration,125

side-effects, 111paravertebral anesthesia, 79patient formulary, 30–1patient selection, 16–29acute disease, 27age, 18–20airway or pulmonary disease,20–1

alcohol or drug abuse,25–6

allergy, 29anesthesia problems, 29breastfeeding patients, 28cardiovascular disease, 91–3diabetes mellitus, 25epileptic patients, 29general considerations,16–18

kidney disease, 28liver disease, 28neurologic diseases, 29obese patients, 24–5pregnant patients, 27psychiatric patients, 27regular medications, 26–7rheumatic disorders, 28–9thyroid disorders, 28

peripheral blocks, 81–3early discharge safety withlong-acting blocks, 83

single lower-extremitysurgery, 81–2

upper-limb surgery, 82personnel, 12–13pharmacodynamics, 38, 46inhalational drugs, 41–2intravenous drugs, 46–50strength of effect, 48–9timing of effect, 46–8type of effect, 49–50

pharmacokinetics, 38inhalational drugs, 39–41intravenous drugs, 43–6

pharmacology, 39 see alsopharmacodynamics;pharmacokinetics

general aspects, 38–9physical requirements, 11–12plasma target concentration, 53plasma target control infusion

(TCI) system, 53versus effect site TCI system,55

PONV see postoperative nauseaand vomiting

post-discharge care, 150–1next-day phone call, 150–1on-call availability, 150outpatient consultation, 151patient questionnaire, 151

postoperative care, 146, see alsopostoperative nausea andvomiting; postoperativepain; post-discharge care

agitation, 147anxiety, 147hospital care, 148–9immediate, in postoperativecare unit, 148–8

pruritus, 146shivering, 146somnolescence, 147urinary retention, 146–7

postoperative care unit,11–12

discharge criteria, 148documentation, 14immediate postoperativecare, 148–8

personnel, 13

Index

183






postoperative nausea andvomiting, 136–7, see alsoanti-emetic drugs

drug treatment principles,140–1

etiology and risk factors,137–9

loco-regional techniquebenefits, 72

non-drug treatment andprophylaxis, 139–40

physiology, 137prophylaxis approach, 143–4risk factors, 138treatment approach, 144

postoperative pain, 106–27, seealso specific analgesics

loco-regional techniquebenefits, 72

medication approach, 127nonopioid analgesics, 109–24nonpharmacologicapproaches, 124

opioids, 109pain physiology, 106–7peroperative management,125–6

postoperative management,126

preoperativemanagement, 125pre-emptive analgesia, 106–7, 126pregabalin, 120–1pregnancy, 27anesthesia, 96

premature infants, 18–19premedication, 98–9anticoagulation, 98–9glucocorticoids, 99obese patients, 94recipe, 152–3

preoperative evaluation, 20preoperative information, 30–5from the patient, 30–1from the physician, 31–2to patient, 32–5

preoperative medication seepremedication

pretreatment, 15procedure selection, 15–16propacetamol, 111propofol, 58–9, 152, 167 see also

intravenous drugschildren, 89, 90, 160

combination with opioids,50–2

elderly patients, 90–1interactions, 43, 50–2, 58pharmacokinetics, 44sedation, 73, 86side-effects, 50, 73target control infusion, 55–6

pruritus, 146psychiatric patients, 27anesthesia, 96

psychoprophylaxis, 124pulmonary disease, 20–1ASA III pulmonary/airwaydisease patients, 91

preoperative information, 31

quality, 4–5loco-regional techniques,72–3

success criteria, 176–7questionnaire, 151

regional anesthesia see alsoloco-regional techniques

regional anesthesia, 13,71–3, 88

definition, 71indications, 84–5intravenous regionalanesthesia, 83

procedures, 77remifentanil, 39, 51, 59–60, 70,

152 see also intravenousdrugs; opioids

children, 160hyperalgesia, 60, 70, 126intubation and, 71sedation, 73, 86side-effects, 73target control infusion, 55

renal disease see kidney diseaserespiratory infections, 20, see

also pulmonary diseaserespiratory side-effects, 49–50revascularization, 22reversal agents, 62–3, 71rheumatoid arthritis, 28–9anesthesia, 97preoperative information, 31

rocuronium, 62, 71ropivacaine, 74, 80runny nose in children, 19

safety, 3–4loco-regional techniques, 72requirements, 11success criteria, 176

sedation, 13, 72–3, 85–6, 122children, 88, 159–61monitoring, 87sedative drug selection,86–7

side-effects, 73self-registration formulary,

30–1serotonin antagonists, 142sevoflurane, 57, 68 see also

inhalational drugschildren, 90pharmacodynamics, 41–2pharmacokinetics, 40–1

shivering, 146side-effectscirculatory effects, 50glucocorticoids, 118information for patient, 33,34–5

NSAIDs, 112–13, 114–15paracetamol, 111respiratory effects, 49–50sedation, 73

sleep apnea syndrome (SAS),21, 91

children, 19obese patients, 93preoperative information, 31

smoking, 20obese patients, 93

sodium channel blockers, 121somnolescence, 147spinal anesthesia, 79–81staff satisfaction, 6, 177–8standards, 11statins, 27strength of effect, 48–9success criteria, 176–8cost-efficacy, 177patient quality, 176–7patient safety, 176staff satisfaction, 177–8

sufentanil, 51, 60sugammadex, 63, 71suxamethonium, 62, 71

T1/2 context-sensitive, 44T1/2 steady-state, 44

Index

184






target control infusion (TCI),52–6, 69–70, 166–7

logic of, 52–4models, 55–6propofol, 55–6recipes, 152–5remifentanil, 55

thiopentone, 58thrombosis prophylaxis,

98–9thyroid disorders, 28anesthesia and, 97

time to peak effect, 46–8tonsillectomy, 161

total intravenous anesthesia(TIVA), 164 see alsointravenous anesthesia;intravenous drugs

development of,166–7

drugs and adjuncts, 166versus inhalationalanesthesia, 165

versus nitrous oxidesupplementation, 164

transient neurologicsymptoms (TNS),79–80

ultrasound-guided procedures, 74nerve blocks, 82

upper-limb surgery, 82urinary retention, 146–7

vecuronium, 62vomiting, 72, see also

postoperative nausea andvomiting

physiology, 137

warfarin, 24wounds, local anesthetic

infusion, 74

Index

185






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