TY - CHAP M1 - Book, Section TI - Chapter 68. Outpatient Anesthesia A1 - Mayers, Douglas B. A1 - Haas, Judith A1 - Convery, Ellen A2 - Longnecker, David E. A2 - Brown, David L. A2 - Newman, Mark F. A2 - Zapol, Warren M. PY - 2012 T2 - Anesthesiology, 2e AB - 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. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/11/09 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=56649945 ER -