Outpatient Surgery Magazine

Manager's Guide to Surgery's Ambulatory Anesthesia - July 2015

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 35 of 68

3 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5 involve a small amount of bleeding, but excessive bleeding is never a positive thing. Anemic patients don't heal as well, and are likely to recover more slowly, points out Dr. Sessler. Meanwhile, in longer, more complex surgeries, excessive blood loss may necessitate transfusions, or greater num- bers of transfusions. If those can be minimized or eliminated by pre-warming, the cost-benefit ratio of pre-warming goes way up. Additionally, says Dr. Sessler, "there's increasing evidence that transfusions are simply bad for you." As outpa- tient facilities continue to expand the complexity of their offerings, minimizing the need for transfusions is bound to become an increasingly significant con- cern. 4. Monitor patients in post-op While outpatient procedures typically involve limited blood loss, the flip side is that the shorter the procedure, the greater the potential impact of hypothermia post-operatively. In longer surgeries, patients typically reach normothermia by procedure's end. "But it's much harder for patients to be normothermic at the end of a short operation," says Dr. Sessler. "It's the 40-minute or 1-hour opera- tion" that presents the biggest challenge." Autonomic responses to cold, like tachycardia and hypertension, are con- trolled when patients are under anesthesia, but not after they wake up. Patients who remain hypothermic in the PACU are thus more likely to experi- ence other consequences. The possibility that patients might have a "heart attack or an infection would likely have more to do with how warm they are at the end of surgery," says Dr. Sessler. "It's likely that the relative importance of intra-operative temperature versus final temperature depends on which outcome you're looking at." Many patients arrive in the chilly early-morning hours. Makes you shiver just thinking about it.

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