Day Care Surgery
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Dr.Vivek Gharpure Consultant pediatric surgeon Children’s surgical hospital Government medical college hospital MIT hospital Aurangabad ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Suitable • Convenient • Safe • Economical • State-of-art ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Rationale
Most procedures do not require any medical treatment once the patient is conscious For clean operations, one or two doses of antibiotics enough For operations not involving any body cavity, observation not required ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• • • • • • •
Conditions suitable Inguinal hernia (except preterm infant) Orchiopexy Circumcision Minor hypospadias Meatotomy/meatoplasty Cleft lip
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Conditions suitable(continued) • Syndactyly/polydactyly • Simple cystoscopy • Upper gi endoscopy/variceal injection • Colonoscopy/sigmoidoscopy • CLN biopsy • Shunt revision ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Polypectomy • Thiersch stitch for prolapse • Removal of foreign body from git ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Patient criteria • • • • •
Otherwise normal Normal hemoglobin Not having respiratory infection Not requiring any additional treatment Should have faith in the surgeon
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Surgeon criteria
• Enough experience with day-care surgery • Should be careful and have a delicate touch to minimize blood loss/surgical trauma • Should be able to manage a delayed recovery or minor complication • Patient should have faith in the surgeon • Surgeon should have faith in day care surgery ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Hospital criteria
• Should have adequate and appropriate equipment to administer general/regional anesthesia to babies • Should have resuscitation and monitoring equipment • Should have trained staff capable of taking care of special needs of children ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Why convenient for surgeon/hospital
• Maximum revenue from the patient is derived from the operative and OT charges • Room charges are not adequate to cover the services provided, particularly for large hospitals • More turnover can result in more revenue and less expenditure ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Why convenient for surgeon/hospital • Surgeons don’t have to take rounds on patients who do not really require any medical attention or medical decision making and make chit-chat • More time can be utilized for other serious patients, public relations, marketing, study etc ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Convenience for patient
• Less time spent away from home • Less money spent on transport, food, entertaining guests • Less money spent on medicines purchased from stores • House need not be locked overnight • Child does not fear the hospital, doctors and staff ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Convenience for patient
• Less antibiotics, less side effects, less requirements for tonics and vitamins • Less requirement for rest and time away from work • Less chances for getting hospital acquired infection ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Convenience for patient • No medicines to take at home • Reduced incidence of nausea and vomiting • Reduced requirement for analgesics ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• Patient has been seen as opd patient some time prior to the procedure • All investigations done on opd basis • Actually no investigations are required for simple opd procedures • NO hemoglobin, NO urine, No other investigation ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• Patient examined one day prior to day of operation and fitness assessed by surgeon • All supplies arranged one day prior • All equipment kept ready • Anesthetist informed and time arranged • Patient informed of the time
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
•
• • •
Methodology Patient told to fast only 4 hours prior to surgery time for liquids/2 hours for water Patient reports 30 minutes before the time fixed for operation Everything is ready for the patient When anesthetist arrives, patient checked again
©Gharpure Hospital
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• Once anesthetist declares patient to be fit, patient taken for surgery • Surgery carried out under general or regional anesthesia • Cautery used to minimize blood loss and handling • Patient returned to ward/room after the procedure ©Gharpure Hospital
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• One dose of antibiotic, usually cefotaxime or ceftriaxone 50mg/kg administered as soon as IV line is established. • 12.5 mg diclofenac suppository inserted after the procedure is over • Iv fluids are continued till patient is conscious • Oral feeds are started 4 hours after the procedure ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology • Iv fluids administration- 20 ml RL/kg given in the first 30 minutes • Then the maintenance requirement • Once patient passes urine, iv discontinued • Soon after patient tolerates first feed of water, feeds quickly increased to milk and then semisolids ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• After patient has taken two/three feeds and passed urine two/three times, he can be discharged home • At home, no antibiotics are given • Analgesics are given on demand, oral paracetamol is preferred • Patient is called for first visit after 48 hours ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• In first visit, wound is not inspected if patient does not have fever and does not complain • Dressing is palpated to check for tenderness, induration, swelling • If wound clean, dressing not opened • Wound inspected if symptoms suggest some problem ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Patient called for second visit on 7th day • Subcuticular suture pulled out and patient sent home • Third visit after one month to check for scar hypertrophy, retained suture etc.
©Gharpure Hospital
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Procedure (n) Herniotomy (243) Orchiopexy (136) Magpi( 107) Chordee correction(98) Ramstedt’s(78) Appendicectomy(45) Cleft lip(67)
Stay in days 1 1 1 2 2 2 2
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Anesthesia considerations • Parents must understand instructions and follow them explicitly • Surgeon should be able to assess anesthesia fitness and take decision • Surgeon should be competent to adminster fluid and electrolytes to children ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Objections • Parents will not look after the child properly This does not occur. Baby does NOT require any special care • Wound infection may occur In clean surgery, antibiotics are not required. Even then we are giving one dose prophylactic antibiotic. Wounds don’t get infected ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Post-operative nausea and vomiting • If patient is not kept fasting for more than 4 hours and is given feeds within 4 hours of the procedure, patients rarely vomit. • No patient has ever received antiemetic after surgery ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital
Procedure (n) Herniotomy (243) Orchiopexy (136) Magpi( 107) Chordee correction(98) Ramstedt’s(78) Appendicectomy(45) Cleft lip(67)
Complication 2 wound infections 1 wound infection None 1 flap necrosis None 1 stitch abscess One minor dehiscence
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Conclusions • Day care surgery feasible for many conditions • Day care surgery safe • Day care surgery economical • Day care surgery convenient ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Sas~ik`yaonaMtr baaLalaa laagaNaaro ]pcaar¸ salaa[na [Mjaoxanacao Daosa yaakirta Aamhalaa dusaáyaa baalaraogat&alaa baaolaavaNyaacaI ikMvaa baaLalaa dusaáyaa Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Happy grandparents ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Happy Mrs.Surgeon
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Dr Vivek Gharpure Consultant Pediatric surgeon Children’s surgical hospital, Aurangabad. Government Medical College, Aurangabad Mithri,Aurangabad. ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Suitable • Convenient • Safe • Economical • State-of-art ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Rationale
Most procedures do not require any medical treatment once the patient is conscious For clean operations, one or two doses of antibiotics enough For operations not involving any body cavity, observation not required ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• • • • • • •
Conditions suitable Inguinal hernia (except preterm infant) Orchiopexy Circumcision Minor hypospadias Meatotomy/meatoplasty Cleft lip
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Conditions suitable(continued) • Syndactyly/polydactyly • Simple cystoscopy • Upper gi endoscopy/variceal injection • Colonoscopy/sigmoidoscopy • CLN biopsy • Shunt revision ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Polypectomy • Thiersch stitch for prolapse • Removal of foreign body from git ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Patient criteria • • • • •
Otherwise normal Normal hemoglobin Not having respiratory infection Not requiring any additional treatment Should have faith in the surgeon
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Surgeon criteria
• Enough experience with day-care surgery • Should be careful and have a delicate touch to minimize blood loss/surgical trauma • Should be able to manage a delayed recovery or minor complication • Patient should have faith in the surgeon • Surgeon should have faith in day care surgery ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Hospital criteria
• Should have adequate and appropriate equipment to administer general/regional anesthesia to babies • Should have resuscitation and monitoring equipment • Should have trained staff capable of taking care of special needs of children ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Why convenient for surgeon/hospital
• Maximum revenue from the patient is derived from the operative and OT charges • Room charges are not adequate to cover the services provided, particularly for large hospitals • More turnover can result in more revenue and less expenditure ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Why convenient for surgeon/hospital • Surgeons don’t have to take rounds on patients who do not really require any medical attention or medical decision making and make chit-chat • More time can be utilized for other serious patients, public relations, marketing, study etc ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Convenience for patient
• Less time spent away from home • Less money spent on transport, food, entertaining guests • Less money spent on medicines purchased from stores • House need not be locked overnight • Child does not fear the hospital, doctors and staff ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Convenience for patient
• Less antibiotics, less side effects, less requirements for tonics and vitamins • Less requirement for rest and time away from work • Less chances for getting hospital acquired infection ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Convenience for patient • No medicines to take at home • Reduced incidence of nausea and vomiting • Reduced requirement for analgesics ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• Patient has been seen as opd patient some time prior to the procedure • All investigations done on opd basis • Actually no investigations are required for simple opd procedures • NO hemoglobin, NO urine, No other investigation ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• Patient examined one day prior to day of operation and fitness assessed by surgeon • All supplies arranged one day prior • All equipment kept ready • Anesthetist informed and time arranged • Patient informed of the time
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
•
• • •
Methodology Patient told to fast only 4 hours prior to surgery time for liquids/2 hours for water Patient reports 30 minutes before the time fixed for operation Everything is ready for the patient When anesthetist arrives, patient checked again
©Gharpure Hospital
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• Once anesthetist declares patient to be fit, patient taken for surgery • Surgery carried out under general or regional anesthesia • Cautery used to minimize blood loss and handling • Patient returned to ward/room after the procedure ©Gharpure Hospital
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology
• One dose of antibiotic, usually cefotaxime or ceftriaxone 50mg/kg administered as soon as IV line is established. • 12.5 mg diclofenac suppository inserted after the procedure is over • Iv fluids are continued till patient is conscious • Oral feeds are started 4 hours after the procedure ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Methodology • Iv fluids administration- 20 ml RL/kg given in the first 30 minutes • Then the maintenance requirement • Once patient passes urine, iv discontinued • Soon after patient tolerates first feed of water, feeds quickly increased to milk and then semisolids ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• After patient has taken two/three feeds and passed urine two/three times, he can be discharged home • At home, no antibiotics are given • Analgesics are given on demand, oral paracetamol is preferred • Patient is called for first visit after 48 hours ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• In first visit, wound is not inspected if patient does not have fever and does not complain • Dressing is palpated to check for tenderness, induration, swelling • If wound clean, dressing not opened • Wound inspected if symptoms suggest some problem ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Patient called for second visit on 7th day • Subcuticular suture pulled out and patient sent home • Third visit after one month to check for scar hypertrophy, retained suture etc.
©Gharpure Hospital
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Procedure (n) Herniotomy (243) Orchiopexy (136) Magpi( 107) Chordee correction(98) Ramstedt’s(78) Appendicectomy(45) Cleft lip(67)
Stay in days 1 1 1 2 2 2 2
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Anesthesia considerations • Parents must understand instructions and follow them explicitly • Surgeon should be able to assess anesthesia fitness and take decision • Surgeon should be competent to adminster fluid and electrolytes to children ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Objections • Parents will not look after the child properly This does not occur. Baby does NOT require any special care • Wound infection may occur In clean surgery, antibiotics are not required. Even then we are giving one dose prophylactic antibiotic. Wounds don’t get infected ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
• Post-operative nausea and vomiting • If patient is not kept fasting for more than 4 hours and is given feeds within 4 hours of the procedure, patients rarely vomit. • No patient has ever received antiemetic after surgery ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital
Procedure (n) Herniotomy (243) Orchiopexy (136) Magpi( 107) Chordee correction(98) Ramstedt’s(78) Appendicectomy(45) Cleft lip(67)
Complication 2 wound infections 1 wound infection None 1 flap necrosis None 1 stitch abscess One minor dehiscence
Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Conclusions • Day care surgery feasible for many conditions • Day care surgery safe • Day care surgery economical • Day care surgery convenient ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Sas~ik`yaonaMtr baaLalaa laagaNaaro ]pcaar¸ salaa[na [Mjaoxanacao Daosa yaakirta Aamhalaa dusaáyaa baalaraogat&alaa baaolaavaNyaacaI ikMvaa baaLalaa dusaáyaa Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Happy grandparents ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Happy Mrs.Surgeon
©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
Dr Vivek Gharpure Consultant Pediatric surgeon Children’s surgical hospital, Aurangabad. Government Medical College, Aurangabad Mithri,Aurangabad. ©Gharpure Hospital Create PDF with GO2PDF for free, if you wish to remove this line, click here to buy Virtual PDF Printer
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