Ambulatory Anaesthesia and Sedation

As pressure on hospital beds increases, more operations are performed on a day-case basis with no overnight stay. This procedure is known as day-case surgery and is being actively encouraged for all suitable operations in order to decrease the occupancy of beds and consequently keep costs down and efficiency up. For the patient there is less disruption of the normal routines of life and no inconvenient overnight stay in an unfamiliar environment. The dramatic increase in the practice of day-case surgery is very recent and has been made possible through the development day-case or ambulatory anaesthesia using newly developed short-acting anaesthetic and sedative drugs. However desirable it may be, the increasing use of ambulatory anaesthesia will inevitably mean that in some cases, patients are released before their sedative/anaesthetic has completely worn off. This raises important questions about residual sedation and impaired function after day-case operations which must be addressed if their full benefits are to be felt. This book explores the problems inherent in assessing the after-effects of anaesthetic and sedative drugs in day-case patients and proposes means of investigating and resolving them. The text covers the after-effects of these drugs, the resulting functional impairment and the assessment of recovery. It discusses the legal implications of such impairment, comparing these with the law concerning alcohol. Different drug groups are discussed in turn, a wide range of tests are evaluated, the problems of special groups (such as the elderly and children) are examined and recommendations are made for future research and practice. The book is divided into sections entitled: Criteria for Assessing Recovery after Anaesthesia, Methods of Assessment, Impairment of Personnel after Acute Drugs, Problems - Acute Drugs and Performance/Recovery and Testing New Drugs for Improved Recovery or Out-patient Use. There is presently no other book on this subject and it will prove immensely valuable to anaesthetists wishing to increase their day-case work, but will also be of interest to theatre staff, psychologists, hospital administrators and lawyers involved in medico-legal work