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1、415AmbulatoryAnesthesia:APrimerfortheOccasionalPractitionerPage1ThomasW.Cutter,M.D.Chicago,IllinoisAdmittoPreopSelectingapatientforanambulatoryprocedureisadynamicprocess.Asimplesetofcriteriaisnotavailabletoreliablydecidebetweenambulatorysurgeryorhospitaladmissio
2、n.Selectionisacomplexprocessthatdependsonthefacility,thepersonnel,theprocedure,andthepatient.Anestheticcareinanambulatorysettingmustbeequivalenttothecarerenderedinahospital.Whileaccreditationforambulatoryfacilitiesisnotrequiredinallstates,thebestandmostdefensibl
3、ecarewillconformtotheguidelinesofanaccreditingagency,suchastheAmericanAssociationforAccreditationofAmbulatorySurgeryFacilities,theJointCommissiononAccreditationofHealthcareOrganizations,ortheAccreditationAssociationforAmbulatoryHealthCare.Outpatientprocedurescan
4、beperformedinavarietyoffacilities.Ahospitalmayintermingleoutpatientwithinpatientproceduresoritmaydevoteaseparatesuiteforambulatoryprocedures.Someorganizationshaveaseparateon-campusbuilding,whicheliminatessomeofthelogisticalcomplexitiesthatareoftenassociatedwithi
5、npatientcare,whileatthesametimemakingaccesseasyforpatientadmissionifnecessary.Outpatientsalsomayhaveproceduresineitherafreestandingsurgicenterorinaprivateofficesetting.Forpatientswhoaremorelikelytobeadmittedafteraprocedure,thehospitaloron-campussettingispreferab
6、letoafreestandingoroffice-basedfacility.Allfacilitiesshouldhavetheequipmentforpreoperative,intraoperative,andpostoperativecare.Anesthesiasuppliesshouldincludeallmedicationsanddevicestosafelyadministerandmonitorananesthetic.Forexample,thefacilitymustbepreparedtod
7、ealwithmalignanthyperthermiaiftriggeringagentsareused.Ifbloodlossisaconcern,bloodmustbeavailableandhemoglobinmonitoredtodeterminewhetherbloodshouldbeadministered.Thefacilitymustbeabletoaccommodatethecomplexityofboththepatientandtheprocedurethroughouttheperiopera
8、tiveperiod.Atransferagreementforadmissiontoaninpatientsettingshouldbeinplace.Aphysicianwhoisassistedonlybyanurseoracertifiednurseanesthetistcanperformsimplerprocedure
