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The location for an outpatient surgical procedure can be either in a hospital or in a freestanding outpatient surgery center. The organizational structure for outpatient surgery centers is determined by their location in relation to a hospital and their governance model.
Evaluation of patients in preparation for outpatient surgery involves the usual standards plus the added issue that the patient is expecting to go home the same day. Thus, the patient must be undergoing a procedure appropriate for same-day discharge and must be physiologically able to go home.
There is no standard "best anesthetic" for outpatient surgery. An anesthetic plan must consider the planned procedure and the patient's physiology in addition to surgeon, anesthesiologist, and patient preferences. The drugs and modalities are chosen for effectiveness and speed of emergence in addition to safety.
Although major morbidity and mortality are rare and hospital admissions and readmissions uncommon, minor morbidities, especially of pain and postdischarge nausea and vomiting, continue to pose significant challenges.
Combination prophylaxis and treatment of postoperative nausea and vomiting is probably the most effective approach combined with adequate hydration and the least emetogenic anesthetic possible for a given procedure.
Multimodal opioid sparing pain management is most effective and enhances patient satisfaction and well being. Widespread use of ultrasound technology has led to improved efficiencies in the performance of peripheral nerve blocks and should remove as a barrier to their performance the belief that an outpatient surgery unit cannot afford their inefficiencies.
The pediatric patient population has special needs requiring family-centered education about the entire perioperative practice. A quiet area for recovery benefits not only the child but also the recovering adult patients.
Although obese patients and patients with obstructive sleep apnea are challenging, with appropriate selection of patient and procedure as well as careful management, these patients once thought unsuitable for outpatient surgery are now safely enjoying its benefits.
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Ambulatory anesthesia in 2010, with its extensive range of surgical interventions, anesthetic techniques, and patient characteristics, is unrecognizable from its historical antecedents, although the reasons for its continued growth are similar to the reasons for its birth: convenience, cost effectiveness, efficiency, and patient and physician satisfaction.1
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Beginning in the 1840s, with neither the thought nor the ability to mix nitrous oxide (N2O) with oxygen, dentists began using 100% N2O for the painless and necessarily expeditious extraction of teeth. Although a practical delivery system for N2O–oxygen mixture was available by the 1880s, the practice of hypoxic anesthesia with N2O continued until the 1950s. In the early 20th century, the entrepreneurial anesthesiologist Ralph Waters began an enterprise that is the prototype of ambulatory surgery centers (ASCs) and office-based anesthesia. In 1915, he took the occasional request for anesthesia services from a dentist with a difficult extraction and turned it into The Downtown Anesthesia Clinic in Sioux City, Iowa, where dental and minor surgical services were performed in a large medical office building, catering to ...