Zasady organizacji systemu i znieczulenia pacjentów w warunkach skróconego okresu okołooperacyjnego (znieczulenia ambulatoryjne, znieczulenie w chirurgii jednego dnia)

Abstract

Since the dawn of civilisation, disease, an inevitable element of human life, has provoked searches for different ways of treatment. Evolving over the centuries, medical management has always focused on the deep-rooted need of an individual for a quick return home. This wish is encapsulated in a motto formulated thousands of years ago by Asclepiades of Bithynia, one of the first doctors. He based treatment on the principle tuto, celeriter et iucunde (safely, swiftly and gladly). The principle seems still applicable to a specific field of surgical management, whose main assumption is to reduce the duration of treatment by rationalising perioperative care [1, 2]. Attempts to shorten the perioperative period to one day go back to the beginning of the 20th century. Nicoll concentrated his efforts on children [3] and Waters on adults [2–4]. In 1962, the first modern facility promoting ‘day case surgery’, a new interdisciplinary field of medicine, was established at the University of California [2, 5, 6]. ‘Day surgery’ and ‘short stay surgery’ are synonymous terms used in literature and in the present paper. The implementation of such activities into the structural solutions of medical management has been demonstrated to give considerable macroeconomic benefits, without increasing the risk of complications and adverse events [2, 5, 6, 7]. Over the last 20 years, the dynamic development of surgical treatment with shortened preand postoperative care has also been observed in Poland. Hence, faced with an amendment to the Ministry of Health regulations concerning the profession of an anaesthesiologist [8], it seems necessary to set out basic recommendations for such services in the reality of the Polish healthcare system, and provide them with an appropriate commentary. RECOMMENDATION NO. 1 Procedures with shortened perioperative periods (short stay surgery, day case surgery, ambulatory surgery) are a special system of patient care and medical management (both anaesthesiological and surgical) that limits a particular elective surgical procedure and all organisational and treatment activities related to it to a single day, (i.e. a period not exceeding 24 hours). In the light of Polish law, such procedures are still considered part of medical services administered by a health care unit (provider) or professional practice.