Anesthetic Management of Adult Ambulatory Surgery in Kyoto University Hospital

• Published in: Nihon Rinshō Masui Gakkai shi Vol. 30; no. 4; pp. 603 - 610
• Main Authors: SATO, Masami, SHIRAKAMI, Gotaro, HIROTA, Kiichi, FUKUDA, Kazuhiko
• Format: Journal Article
• Language: Japanese; English
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 2010
• Subjects: Adult; Ambulatory anesthesia; Ambulatory surgery system; Perioperative care
• ISSN: 0285-4945; 1349-9149
• DOI: 10.2199/jjsca.30.603

The day surgery unit (DSU) in Kyoto University Hospital was founded as the first facility for ambulatory surgery among the Japanese national university hospitals in January 2000, so as to establish a safe, high-quality and cost-effective management system of ambulatory surgery and to popularize day-case surgery in our country. By the end of 2009, a total of 10,148 patients underwent operations under the supervision of anesthesiologists in the DSU. The techniques and procedures in anesthesia and perioperative care in the DSU have been modified and improved year by year. A representative example is day-case hysteroscopy: monitored anesthesia care (MAC) using propofol sedation and paracervical block has led to the shortening of the postanesthesia recovery and discharge times and improved patient's self-assessment of the resumption of normal activity level, compared to the original anesthetic method using sevoflurane. Similarly, thoracic paravertebral block along with MAC brought about a smoother postanesthesia recovery in breast cancer surgery. Our experience of over 9 years indicates the significance of the cooperation with nursing, surgical and anesthesia personnel and constant efforts to collect and analyze the perioperative information, especially undesired symptoms that delay postoperative recovery, and patients' demands for establishment of an ambulatory surgery system that is secure and high patient satisfaction.