anestesia para cirugia ambulatoria 3

Anestesia para cirugía ambulatoria en pediatría (day case)…

Silvana Cavallieri Departamento de Anestesiología HLCM HL CM-- Cl Clín ínica ica Las Las Condes

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Plan •

Definición. Historia. Requisitos

•

Criterios •

Selección Selección Pacient Pacientes es

•

Anestesia

•

Criterios alta prima imaria y se secund undaria

•

Aspe Aspect ctos os conf confor ortt paci pacien ente te

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Historia •

•

•

Siglo 19 cirugía ambulatoria Clorformo y éter cirugia paciente hospitalizado. 1909: Nicoll cirujano pediatra. 1 reporte cirugía ambulatoria. °

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MAGNITUD Cirugía ambulatoria ambulatoria •

•

•

Usa: 70-84% de la cirugía pediátrica electiva (2,3 millones de pacientes en 2006) UK: objetivo llegar al 75%

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Definición Criterios •

Administrativos

•

Gerenciaes

•

Arquitectónicos

•

  Etc…

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Porqué cirugía ambulatoria

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Premisa Cirugía ambulatoria debe recomendarse cuando esta practica disminuye el sufrimiento y los

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Otras ventajas •

Disminuye costos costos

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Requisitos de las facilidades •

Normativas

•

Procesos definidos

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Criterios Inclusión

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Peds eds PADSS ADSS

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¿Qué pasa después?

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DOLOR-tears at home

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Manejo dolor •

¿Que deberíamos hacer?  –

Analgesia potente y a tiempo

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¿Qué analgésic analgésicos? os? Intrahospitalario  –

Aines: Ketorolaco; Ketoprofeno

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Paracetamol

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Paracetamol IV: Farmacocinética

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Alternativas analgesia postoperatorio

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Otras drogas

•

•

Metoclopramida   Cinerizina

 –

NO

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Dolor postoperatorio

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Casos específicos

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El caso susceptible HM •

•

•

Evitar Evitar gatillantes (<1% incidencia) Misma consideraciones que cualquier otro paciente Alta: 2,5 horas sin eventos eventos

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El caso de la AA y la apnea obstructiva obstructiva

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Morbilidad A&A: 0.6/10.000

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OSAS y Riesgo complicaciones en AA •

(descrito solo en 1976)

•

OSAS

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•

Incidencia complicaciones: 6.4% -27%

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Complicaciones Complicaciones en paciente portador

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Apnea obstructiva por hipertrofia

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