Outpatient Anesthesia

Dr. Kohar Hari Santoso, dr. SpAn. KIC.KAP

Lila Tri Harjana, dr. SpAn.
Anestesiologi & Reanimasi
FK Unair / RSUD Dr. Soetomo
Tujuan Instruksional Umum
Memahami Anestesia Rawat Jalan

Tujuan Instruksional Khusus

setelah mengikuti sesi ini peserta akan dapat:
1. Menyebutkan pengertian anestesia rawat jalan
2. Menjelaskan keuntungan anestesia rawat jalan
3. Menjelaskan kriteria pasien untuk anestesia
rawat jalan
4. Menjelaskan persiapan pra anestesia
5. Menjelaskan tehnik anestesia rawat jalan
6. Menjelaskan pengelolaan pascaanestesia
 Mean & Synonims

• Anesthesia procedure without hospital

admission for day-stay surgery.
• Day case anesthesia
• One day service anesthesia
• Ambulatory anesthesia
• Anestesia Rawat Jalan
• Anestesia tanpa mondok
 Advantages of day-stay surgery
• Shorter waiting time for operation
• Avoids psychological trauma of prolonged
separation from parents and home
• Shortens inpatient operation waiting lists
• Lower infection rate
• No “hotel” cost and lower nursing cost
• No night or weekend duty
• No repeated hospital visiting
 Patient Case Selection
• Less than 1 hour surgical procedure
• Undue haemorrhage
• Without severe post operative pain
• Fitness rating of ASA grade I or II
• Mostly for Diagnostic Procedure
• Mostly at Non-operating Room
Anesthesia (NORA) or Office-based
Anesthesia (OBA)
 Instruction for the patient
• Fasten preanesthesia
• Identified current medication & allergy
• Be accompanied at home & to hospital
• Abstain from alkohol & smoke
• Not drive a car or work machinery for 3 days
 Preoperative evaluation
• Taking Medical history
• Physical & laboratory evaluation
• Explanation anesthesia plan
• Informed consent
 Preanesthesia preparation
• Patient preparation
• Readiness Equipment
• Drugs & agent choicing

The aim of anesthesia is safety.

Safety is begin with meticulous
preoperative evaluation
 Preanesthesia fasten

AGE Milk & Food Clear Water

< 6 months 4 hours 2 hours
6 – 36 months 6 hours 3 hours
> 36 months 8 hours 3 hours

Unfasten not reason to postpone emergency operation

The aim of Infusion

• IV line for drugs & emergency situation

• Maintenance
• Replacement

What’s wrong in this

infusion technique ?
 Drugs & agent choicing
1. Short on set
2. Short Duration
3. Minimally hang over
 Anesthesia Technique Considerations
• Premedication
• General or Regional Anesthesia ?
• Intravenous anesthetic drug
• Volatile anesthetic agent
• Masker or intubation ?
• Monitoring during anesthesia
• Operation procedure or technique
 Monitoring During Surgery
• Secure the airway • Anesthesia Machine
• Breathing adequaty • Agent anesthesia
• Hemodynamic stability • IV line
• Level of unconciousness • Estimated Blood Loss
• Urine prodction ( if use • Surgical field
catteter) • Environment theatre
What happen in this picture ?
 Postoperative Consideration
• Physiology evaluation
• Analgesic
• Realimentation
• Mobilisation & Discharge

Don’t give pillow

For unconcious
patient
 Realimentation

• Conciuosness
• Gastrointestinal Assessment
• Gradual( MSS = minum sedikit sedikit)
Gastro Intestinal segmentation
1. Upper
 esofagus – lambung
(pylorus )
2.Middle
 Usus halus
(s/d ileo caecal junction )
3. Lower
 Caecum – colon – sigmoid -
rectum
Assessment GI Function

Part of GI Signs

Upper Nausea & Vomiting

NG tube production
Middle Peristaltic sounds

Lower Flatus
 Complications

• Headache • Dizziness
• Drowsiness • Sore Throat
• Nausea • Injection site pain
• Vomiting • Muscle stiffness
Risk factors for PONV

• Patient Factors
• Anesthetic techniques
• Surgical Procedures
Patient factors
• Young age
• Female gender, particularly if menstruating on
day of surgery or in first trimester of
pregnancy
• History of prior postoperative emesis
• History of motion sickness
• Delayed gastric emptying (eg. Obesity )
Anesthetic Technique Factors
• Opioid administration
• General anesthesia
• Anesthetic drugs
• Post operative pain
• Hypotension
Surgical Procedure Factors
• Strabismus surgery
• Ear surgery
• Laparoscopy
• Orchidopexy
• Ovum retrieval
• Tonsilectomy
 Discharge Criteria
• Orientation to person, place and time
• Stable vital signs for 30 – 60 minutes
• Ability to ambulate unassisted
• Ability to tolerate oral fluids
• Ability to void
• Absence of significant pain or bleeding
 Take Home Message
The standards of anesthesia care and
patient monitoring are the same
regardless of location
Thank you