专题笔谈

快速康复外科理念下日间手术的麻醉与围术期质量控制

  • 钱玥 ,
  • 马正良
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  • 南京大学医学院附属鼓楼医院麻醉科 (南京 210008 )
马正良,南京大学医学院附属鼓楼医院麻醉医学中心主任,教授,博士研究生导师。中国研究型医院学会麻醉专业委员会主席,中华医学会麻醉学分会第十二届、十三届常务委员,中华医学会麻醉学分会门诊、PACU及日间手术学组第十二、十三届组长,江苏省医学会麻醉学分会第九届主任委员,江苏省医师协会麻醉学医师分会第三届会长。《中华麻醉学杂志》、《临床麻醉学杂志》、《国际麻醉学与复苏杂志》等多家杂志副编委、常务编委。主持国家自然科学基金9项,省级以上课题10余项。已发表统计源期刊论文300余篇,SCI收录100余篇。荣获江苏省科学技术奖二等奖3项、江苏省医学新技术引进奖一等奖4项。入选省“科教兴卫工程”医学重点人才、省“333”工程第二层次,省六大人才高峰人才。

收稿日期: 2023-09-10

  网络出版日期: 2024-04-19

Anesthesia and perioperative quality control of ambulatory surgery under the concept of rapid recovery surgery

  • Yue QIAN ,
  • Zhengliang. MA
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  • Department of Anesthesia,Drum Tower Hospital,Nanjing 210008,China

Received date: 2023-09-10

  Online published: 2024-04-19

摘要

日间手术模式是一种加速康复理念下的手术诊疗康复体系,我国的日间手术正处于高速发展状态中,日间手术医疗质量管理也越来越受到重视。本文围绕日间手术的围术期管理进行了阐述,从患者选择、手术麻醉选择、术中管理、术后镇痛、术后恶心呕吐管理和出院随访等方面探讨了日间手术的管理细节,旨在建立统一的日间手术麻醉质量管理模式、进行全面的质量改进,为临床日间手术管理提供更恰当的日间手术管理方法,才能更好地促进日间手术的健康、快速、高效的发展。

本文引用格式

钱玥 , 马正良 . 快速康复外科理念下日间手术的麻醉与围术期质量控制[J]. 实用医学杂志, 2024 , 40(8) : 1042 -1046 . DOI: 10.3969/j.issn.1006-5725.2024.08.003

Abstract

The ambulatory surgery mode is a surgical diagnosis, treatment, and rehabilitation system based on the concept of rapid recovery. Ambulatory surgery in our country is in a state of rapid development, and the medical quality management of ambulatory surgery is also receiving increasing attention. This article elaborates on the perioperative management of ambulatory surgery, exploring the management details of daytime surgery from various aspects such as patient selection, surgical anesthesia selection, intraoperative management, postoperative pain relief, nausea and vomiting management, and discharge follow-up. Intended to establish a unified quality management model for ambulatory surgical anesthesia and conduct comprehensive quality improvement. We hope it could provide more appropriate methods for clinical ambulatory surgery management, promote the healthy, rapid, and efficient development of ambulatory surgery.

参考文献

1 马正良, 黄宇光, 顾小萍,等. 成人日间手术加速康复外科麻醉管理专家共识[J]. 协和医学杂志, 2019, 10(6):562-569.
2 JOSHI G P, ABDELMALAK B B, WEIGEL W A, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting[J]. Anesthesiology, 2023,138(2):132-151. doi:10.1097/aln.0000000000004381
3 中华医学会麻醉学分会. 日间手术麻醉专家共识[J]. 临床麻醉学杂志, 2016,32(10):1017-1022.
4 PAYAL A R, SOLA-DEL VALLE D, GONZALEZ-GONZALEZ L A, et al. American Society of Anesthesiologists classification in cataract surgery: results from the ophthalmic surgery outcomes data project[J]. J Cataract Refract Surg, 2016,42(7):972-982. doi:10.1016/j.jcrs.2016.04.032
5 程智刚, 姜媛, 王云姣, 等. 规范日间手术麻醉管理[J]. 国际麻醉学与复苏杂志, 2021, 42(12):1237-1239. doi:10.3760/cma.j.cn321761-20211114-00425
6 MCISAAC D I, MACDONALD D B, AUCOIN S D. Frailty for perioperative clinicians: a narrative review[J]. Anesth Analg,2020,130(6):1450-1460. doi:10.1213/ane.0000000000004602
7 郭科迪, 武岩, 汤夕慧, 等. 术前衰弱对老年肺癌患者术后并发症的影响[J]. 实用医学杂志, 2023, 39(15):1956-1960. doi:10.3969/j.issn.1006-5725.2023.15.017
8 MCISAAC D I, MACDONALD D B, AUCOIN S D. Frailty for perioperative clinicians: a narrative review[J]. Anesth Analg, 2020,130:1450-1460. doi:10.1213/ane.0000000000004602
9 GREWAL G, JOSHI G P. Obesity and obstructive sleep apnea in the ambulatory patient[J]. Anesthesiol Clin, 2019,37:215-224. doi:10.1016/j.anclin.2019.01.001
10 GABRIEL R A, BURTON B N, INGRANDE J, et al. The association of body mass index with same-day hospital admission, postoperative complications, and 30-day readmission following day-case eligible joint arthroscopy: a national registry analysis[J]. J Clin Anesth, 2020,59:26-31. doi:10.1016/j.jclinane.2019.06.012
11 ROSERO E B, JOSHI G P. Finding the body mass index cutoff for hospital readmission after ambulatory hernia surgery[J]. Acta Anaesthesiol Scand, 2020,64(9):1270-1277. doi:10.1111/aas.13660
12 JOSHI G P, AHMAD S, RIAD W,et al. Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature[J]. Anesth Analg, 2013,117(5):1082-1091. doi:10.1213/ane.0b013e3182a823f4
13 JOSHI G P, CHUNG F, VANN M A, et al.Society for Ambulatory Anesthesia. Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery[J]. Anesth Analg, 2010,111(6):1378-1387. doi:10.1213/ane.0b013e3181f9c288
14 中华医学会麻醉学分会“麻醉门诊建设专家指导意见”工作小组. 麻醉科门诊建设专家指导意见[J]. 中华麻醉学杂志, 2019, 39(1):7-13.
15 SKUES M A. High-risk surgical procedures and semi-emergent surgical procedures for ambulatory surgery[J]. Curr Opin Anaesthesiol, 2020,33(6):718-723. doi:10.1097/aco.0000000000000918
16 MEMTSOUDIS S G, COZOWICZ C, BEKERIS J, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature[J]. Reg Anesth Pain Med, 2021,46(11):971-985. doi:10.1136/rapm-2021-102750
17 CHOI J W, LAHORI A, MERLO J A, et al. Adductor canal blocks with bupivacaine and magnesium after same-day discharge total knee arthroplasty improve postoperative pain relief and decrease opioid consumption: a prospective randomized controlled trial[J]. Clin J Pain, 2022,38(6):388-395. doi:10.1097/ajp.0000000000001036
18 SCHUBERT A K, WIESMANN T, WULF H, et al. Spinal anesthesia in ambulatory surgery[J]. Best Pract Res Clin Anaesthesiol, 2023,37(2):109-121. doi:10.1016/j.bpa.2023.04.002
19 CAPDEVILA X, AVELINE C, DELAUNAY L, et al. Factors determining the choice of spinal versus general anesthesia in patients undergoing ambulatory surgery: results of a multicenter observational study[J]. Adv Ther, 2020,37(1):527-540. doi:10.1007/s12325-019-01171-6
20 YOUNG C C, HARRIS E M, VACCHIANO C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations[J]. Br J Anaesth, 2019,123(6):898-913. doi:10.1016/j.bja.2019.08.017
21 GRUNE F, KAZMAIER S, SONNTAG H, et al. Moderate hyperventilation during intravenous anesthesia increases net cerebral lactate efflux[J]. Anesthesiology, 2014,120(2):335-342. doi:10.1097/aln.0b013e3182a8eb09
22 MENG L Z, YU W F, WANG T L,et al. Blood Pressure Targets in Perioperative Care[J]. Hypertension, 2018, 72(4): 806-817. doi:10.1161/hypertensionaha.118.11688
23 YANG M M H, HARTLEY R L, LEUNG A A, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis[J]. BMJ Open, 2019,9(4):e025091. doi:10.1136/bmjopen-2018-025091
24 祝胜美, 刘甬民. 日间手术患者术后镇痛管理[J]. 现代实用医学, 2019, 31(2):141-144. doi:10.3969/j.issn.1671-0800.2019.02.001
25 CHOU R, GORDON D B, DE LEON-CASASOLA O A,et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council[J]. J Pain, 2016; 17(2):131-157. doi:10.1016/j.jpain.2015.12.008
26 徐建国. 成人日间手术后镇痛专家共识(2017)[J]. 临床麻醉学杂志, 2017, 33(8):812-815.
27 JOSHI G P, VAN DE VELDE M, KEHLET H, et al. PROSPECT Working Group Collaborators. Development of evidence-based recommendations for procedurespecific pain management: PROSPECT methodology[J]. Anaesthesia, 2019,74(10):1298-1304. doi:10.1111/anae.14776
28 JT G, GK B, SERGIO B, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting[J]. Anesth Analg, 2020, 131(2):411-448. doi:10.1213/ane.0000000000005245
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