Diez R-Labajo A
Hospital Virgen de la Torre, Madrid, Spain.
Curr Opin Anaesthesiol. 1998 Dec;11(6):615-21.
Health care delivery is undergoing a revolutionary change. It is focusing rapidly all over the world towards outpatient and home care. One of the most obvious results of these changes has been the relative explosion office-based surgery and anesthesia; however, these are not new concepts. Dentistry and office-based anesthesia have always been closely intertwined. In 1844, two dentists, Wells and Morton, changed the practice of anesthesia firstly with the use of nitrous oxide and secondly with ether for tooth extraction. Thereafter, office-based surgery and anesthesia continued to evolve. In the past two decades, the rapid development of new surgical technologies and pharmaceuticals have facilitated the movement of more invasive surgical procedures and anesthesia to less invasive settings, such as the doctor's office. The most significant recent changes in health care are changes in the consumer, the practitioner and the provider. All are demanding high quality anesthesia and surgery care at a reduced cost. Articles describing almost every type of surgical and anesthetic techniques in the office can be found in the literature. However, the success of providing safe and cost-effective surgical and anesthetic care at an office depends on major issues, including adequate selection of the surgical procedure, complete preoperative assessment of the patient's state of health and adequate equipment and design of the unit. It is incumbent upon practitioners to make certain that the safety of the hospitals is not sacrificed in the office setting. Health care has to be delivered as safely in the office as it would be elsewhere. Regulations and guidelines should be established in consultation with surgeons, anesthesiologists and administrators to ensure safe health care. These guidelines should be based on the specific type of surgery, the level of anesthetic required and the design of the office. This way the provision of adequate quality of care is ensured. Office-based anesthesia and surgery will no doubt continue to evolve because it is safe, pleasing and convenient for the patient and of low cost.
医疗保健服务正在经历一场革命性的变革。全球范围内正迅速将重点转向门诊和家庭护理。这些变化最明显的结果之一是门诊手术和麻醉的相对激增；然而，这些并非新概念。牙科和门诊麻醉一直紧密相连。1844年，两位牙医韦尔斯和莫顿，首先使用一氧化二氮，其次使用乙醚进行拔牙，从而改变了麻醉的实践方式。此后，门诊手术和麻醉不断发展。在过去二十年中，新手术技术和药物的快速发展推动了更多侵入性手术和麻醉向侵入性较小的环境转移，比如医生办公室。医疗保健领域最近最显著的变化在于消费者、从业者和提供者。所有人都要求以降低的成本获得高质量的麻醉和手术护理。文献中可以找到描述几乎每种门诊手术和麻醉技术的文章。然而，在办公室提供安全且具有成本效益的手术和麻醉护理的成功取决于一些主要问题，包括手术程序的适当选择、患者健康状况的全面术前评估以及设备的充分配备和科室的设计。从业者有责任确保在办公室环境中不牺牲医院的安全性。在办公室提供医疗保健必须和在其他地方一样安全。应与外科医生、麻醉师和管理人员协商制定法规和指南，以确保医疗保健安全。这些指南应基于手术的具体类型、所需麻醉水平和办公室的设计。这样就能确保提供足够质量的护理。毫无疑问，门诊麻醉和手术将继续发展，因为它对患者来说安全、舒适且方便，成本也低。
