Anaesthesia and day case surgery

Dnevna kirurgija je relativno nov te sve prisutniji pristup zbrinjavanja kirurških bolesnika. Rezultat je snažnog ekonomskog pritiska na zdravstvo s ciljem smanjenja troškova bolničkog liječenja a omogućen znatnim napretkom kirurške tehnike i tehnologije, napretkom u anesteziološkim tehnikama, razvojem modernih anestetika te rastom znanja i iskustva u zbrinjavanju bolesnika u dnevnoj kirurgiji. Preduvjeti uspješnog liječenja u dnevnoj kirurgiji uključuju odgovarajući izbor kirurškog zahvata, odabir i priprema bolesnika, odgovarajući izbor anesteziološke tehnike i anestetika. U odabiru bolesnika preporučuje se multidisciplinaran pristup uzimajući u obzir kirurške, medicinske i socijalne kriterije. Odgovornost anesteziologa u dnevnoj kirurgiji je velika. Većina zahvata u dnevnoj kirurgiji ne rezultira znatnijom kirurškom traumom pa otpust bolesnika ovisi najviše o oporavku od anestezije. Otpust bolesnika može biti odgođen pojavom poslijeoperacijskih komplikacija poput mučnine i povraćanja te boli. Zadatak je anesteziologa spriječiti pojavu navedenih komplikacija te na taj način očuvati koncept dnevne kirurgije u korist bolesnika i zdravstvenog sustava u cjelini.Day case surgery is a relatively new and increasingly practiced approach of providing care to surgical patients. It is a result of strong economic pressures on health care services targeted to minimize hospital cost. Such change in approach has been enabled by advancement in surgical and anaesthesia technique and technology, development of moderns anaesthetics and growth in knowledge and experience. A prerequisite of successful treatment in day case surgery is a careful selection of suitable surgical procedures for suitable patients, patient preparation, proper selection of anaesthetic techniques, and anaesthetics. Multidisciplinary approach is recommended when selecting patients while taking into account surgical, medical and social criteria. The anaesthesiologist has a great responsibility for patient care. Most of the day case procedures in carefully assessed and selected patients do not result in a significant surgical trauma therefore discharge of patients mostly depends on recovery from anaesthesia. Patient discharge may be delayed by postoperative complications such as pain and postoperative nausea and vomiting. It is the anaesthesiologists task to prevent mentioned complications and in that way preserve the concept of outpatient surgery for the benefit of patients and the health care system altogether