Ambulatory (Outpatient) Anesthesia

Ambulatory surgery is continuing to expand as a result of less invasive surgical techniques, improved patient selection, and a growth in ambulatory non-operating room and office-based practice. There are now relatively few absolute contraindications to ambulatory surgery and patients should not be excluded on the basis of arbitrary limits or criteria. The safety and success of ambulatory surgery are dependent on effective preoperative assessment, with careful evaluation and preparation of patients. A number of anesthetics and techniques are appropriate for ambulatory surgery, including spinal anesthesia and sedative techniques. All require experience and careful attention to detail in order to deliver high-quality rapid recovery with minimal side effects. Multimodal analgesia, using combinations of local or regional anesthesia, acetaminophen, and nonsteroidal anti-inflammatory drugs, provide effective relief of pain, while a reduced requirement for opioids decreases the incidence and intensity of adverse effects. Control of postoperative nausea and vomiting is especially important, with antiemetic prophylaxis provided on the basis of individual patient risk, using multimodal regimens for patients and procedures at significant risk for complications. The provision of written information concerning aftercare, return to normal activities, follow-up evaluation, relevant contacts, and early warning signs of potential problems, plus the appropriate action to take, help maintain the popularity of ambulatory surgery with patients and ensure its continuing safety.