Chapter 34 Outpatient Anesthesia
History of outpatient surgery and keys to success
1. Who created the first outpatient surgery center? When, where, and why?
2. What are the four most important areas to focus on to ensure success in outpatient anesthesia and surgery?
3. What are the primary determinants of predictability of duration and quality of surgical procedures in the ambulatory surgery center?
4. In comparison to hospital practice, is patient safety training usually less of a concern in an outpatient surgery setting, since patients are healthier and procedures are less invasive?
5. Is there value in monitoring of outcomes and the use of that data to support standard care practice (algorithms) and have these techniques been useful in creating higher quality care and improved patient safety?
Techniques of anesthesia for outpatient surgery
8. Monitored anesthesia care (MAC) may provide just as much risk as general anesthesia. What risk may be greater for MAC than general?
9. Use of regional anesthesia can result in what process improvements in the outpatient surgery suite?
10. Does neuraxial anesthesia delay discharge of outpatients, particularly elderly males?
11. Should neuraxial anesthesia be avoided because it has a high incidence of postoperative urinary retention?
12. The use of general anesthesia, when compared to regional anesthesia or MAC, increases the likelihood of which four negative outcomes in outpatient anesthesia and surgery?
13. Avoidance of what three anesthetic techniques will increase patient satisfaction, and decrease the likelihood of postoperative nausea and vomiting and postoperative cognitive dysfunction?
Topics of importance in outpatient anesthesia
14. What preoperative Hb A1c level indicates that it is “safe” for outpatient surgery to proceed?
15. What is the “rule of 1800” for dosing insulin and how is it useful on the day of surgery?
16. Is the use of dexamethasone appropriate to decrease the risk of postoperative nausea and vomiting in the patient with diabetes?
17. Is it true that treated hypertension is not a predictor of perioperative morbidity?
18. What are the considerations for deciding to provide anesthesia for a patient with a known or suspected personal history of malignant hyperthermia in a freestanding ambulatory surgical center?
19. Which risks are associated with obstructive sleep apnea (OSA)?
20. Of what value is preoperative evaluation and treatment of OSA?
21. What factors would lead to a patient with OSA being cared for in a hospital setting rather than a freestanding ambulatory surgery center?
22. What is the most common cause of perioperative injury associated with remote-site (e.g., office-based) surgery?
23. What factors increase the risk of perioperative trouble in the office setting?
24. What are the advantages of using multimodal analgesia in the outpatient surgery setting?
25. What postoperative plan should cause the team to reconsider the outpatient venue for a case?
26. How soon does tonsillectomy relieve moderate or severe obstructive sleep apnea in pediatric patients and what implication does that have for when and where this procedure should be performed in this patient population?
27. What postoperative complication do outpatient surgery patients rank the prevention of as high as they do the prevention and treatment of pain?
28. Use of the Apfel score to predict postoperative nausea and vomiting has proven valid only for which time period after surgery?
29. What regimen of prophylaxis can virtually eliminate both early and late postoperative and postdischarge nausea and vomiting (PONV/PDNV) in even the highest risk patients?
30. If PONV occurs after the use of ondansetron in the operating room, what should be used to treat it?
31. When should the presence of an upper respiratory infection lead to cancellation of an elective surgical procedure?
32. How should the availability of 23-hour stay facilities affect patient selection for outpatient surgery?
33. Should all patients remain at least 2 hours on site in a free-standing surgery center once in the recovery room (postanesthesia care unit [PACU])?
