Chapter 27 - Anesthesia for Ambulatory Surgical Procedures

Summary

Ambulatory surgery centers (ASCs) have become the place of choice for an increasing number of diagnostic and surgical procedures. Improvements in anesthesia and pain control, minimally invasive surgical techniques, patient expectations, and economic factors have driven this increase in number and complexity of procedures performed at ASCs. Patients with significant comorbidities are also making up an increasing proportion of the population undergoing ambulatory procedures. There are multiple advantages with performing same-day surgical procedures in this setting – the cost of care is lower, in comparison with same-day procedures performed in hospital; waiting times and ease of access are also more convenient for patients and caretakers; and physicians can maximize the use of their operating room time by having efficient scheduling practices. At the same time, and in order to maintain the viability of ASCs, it is fundamental to understand the factors that make for a successful ambulatory surgical practice, such as optimal patient and procedure selection, preoperative preparation, anesthesia management and pain control strategies, management of postanesthesia care unit (PACU) complications, appropriate staffing and management of human resources, and contingency plans in the event of changes in patient condition that require hospital admission for further diagnosis or treatment.