International anesthesiology clinics
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Regional anesthesia has several distinct advantages over general anesthesia in the patient scheduled for ambulatory surgery. These include residual analgesia and a lower incidence of postoperative nausea and vomiting. With appropriate choice of regional technique and local anesthetic drug, earlier ambulation and discharge are often possible. ⋯ Regional anesthesia requires more time to administer than does general anesthesia, and ideally should be performed in an induction area. However, use of such an area, or employment of techniques with a rapid onset of analgesia (e.g., intravenous regional of spinal anesthesia) may actually reduce the total amount of time a patient spends in the ambulatory unit [16]. Selected application of regional techniques will help convince surgeons, anesthesiologists, and nurses of the advantages of regional blockade and may ultimately lead to greater patient and surgeon satisfaction.
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The practice of ambulatory surgery is rapidly expanding, not only the type of surgeries performed, but more "at risk" patients are being allowed outpatient procedures. Warner and colleagues [56] recently published the results of a large prospective outcome survey of morbidity and mortality after ambulatory surgery. Of the 38,598 patients studied, 31 patients experienced a major morbidity (1:1455) and 4 died (2 myocardial infarctions and 2 motor vehicle accidents) (Table 7). ⋯ Given the overall low morbidity and mortality rates, it is likely that ambulatory surgery will continue to grow in the future. Improved preoperative assessment and preparation will further increase the number of acceptable candidates for ambulatory surgery. Having recognized the special needs of the surgical outpatient, anesthesiologists should modify their practice patterns to meet the psychological and pharmacological requirements of the outpatient undergoing an elective surgical procedure.