ANESTHESIA FOR ONE-DAY SURGERY   Free access

Minerva Anestesiologica 1999 June;65(6):405-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

New anaesthetics & techniques for day case surgery

Smith I.

Keele University, Consultant Anaesthetic, North Staffordshire Hospital Stroke-on-Trent

A varie­ty of ­drugs and tech­niques ­have ­been intro­duced ­into day sur­gery ­over ­recent ­years and, ­although the ­tide of devel­op­ment ­appears to ­have ­slowed, may of ­these ­will ­still be rel­a­tive­ly new to ­many. Experience ­with the laryn­geal ­mask con­tin­ues to ­grow and it is now a firm­ly-estab­lished air­way man­age­ment ­tool in a ­wide varie­ty of pro­ce­dures. The ­cuffed oroph­a­ryn­geal air­way is an inter­est­ing ­recent arri­val, but pro­duc­es infe­ri­or air­way con­trol and is not a ­true alter­na­tive to the laryn­geal ­mask.
Desflurane and sevof­lu­rane ­offer fast­er recov­ery ­through low sol­u­bil­ity ­although the dif­fer­enc­es are ­small. Sevoflurane ­offers the inter­est­ing pros­pect of inha­la­tion induc­tion open­ing up the pos­sibil­ity of a rad­i­cal ­change in tech­nique and phi­los­o­phy. In the intra­ve­nous are­na remi­fen­ta­nil ­offers ­short-­lived opi­oid ­side ­effects, but ­also ­short-­lived anal­ge­sia, ­while pro­pof­ol has a new, com­put­er-assist­ed deliv­ery ­system. In com­bi­na­tion, ­these devel­op­ments ­offer ­another oppor­tu­nity for a dra­mat­i­cal­ly ­altered tech­nique.
The ­long-await­ed “­depth of anaesthe­sia” mon­i­tor may ­have ­arrived, offer­ing the pos­sibil­ity of ­more fine­ly titrat­ed anaesthe­sia ­with ear­li­er (but not intra­op­er­a­tive!) awak­en­ing. Reliability is as yet uncer­tain and a sim­ple tech­nique ­with spon­ta­ne­ous ven­ti­la­tion may ­achieve sim­i­lar ­results at sub­stan­tial­ly low­er ­cost. The rel­a­tive ­place of all ­these devel­op­ments ­will ­take sev­er­al ­years to ­become appar­ent and the ­future ­remains inter­est­ing.