Chapter 68
- Ambulatory (Outpatient) Anesthesia
- Paul F. White
- Alejandro Recart Freire
In the early 1900s, an American anesthesiologist, Ralph Waters,
opened an outpatient anesthesia clinic in Sioux City, Iowa.[1]
This facility, which provided care for dental and minor surgery cases, is generally
regarded as the prototype for the modern freestanding ambulatory (and office-based)
surgery center. Interestingly, there was little interest in ambulatory surgical
care until the late 1960s, when the first hospital-based ambulatory surgery units
were developed. Over the last 3 decades, outpatient surgery has grown at an exponential
rate, progressing from the practice of performing simple procedures on healthy outpatients
to encompassing a broad spectrum of patient care in freestanding ambulatory surgery
centers. Formal development of ambulatory anesthesia as a subspecialty occurred
with establishment of the Society for Ambulatory Anesthesia (SAMBA) in 1984 and the
subsequent development of postgraduate subspecialty training programs.
By 1985, 7 million elective operations in the United States (over
30% of all elective surgical procedures) were performed on an ambulatory basis.
Currently, more than 60% of all elective surgery is performed in the outpatient surgical
setting, and it is expected that this number will increase to more than 70% in the
near future.[2]
The expanding number of freestanding
diagnostic and surgical treatment centers around the world reflects the interest
in reducing the need for hospitalization.[3]
However,
the growth in ambulatory surgery would have not been possible without the development
of improved anesthetic and surgical techniques.[4]
The availability of rapid, shorter-acting anesthetic, analgesic, and muscle relaxant
drugs has clearly facilitated the recovery process and allowed more extensive procedures
to be performed on an ambulatory basis, irrespective of preexisting medical conditions.
[5]
The range of acceptable ambulatory surgical procedures continues
to expand, and patients are presenting for outpatient surgery with increasingly complex
medical problems. As a result, anesthesiologists must play a more active role in
the preoperative assessment and preparation of these patients to avoid costly delays
and last minute cancellations.[6]
In modern ambulatory
facilities,
surgical procedures are safely performed without sacrificing quality while minimizing
hospital resources.[7]
In an era of cost containment,
the savings inherent in providing increased ambulatory services ensures that the
number of outpatient surgical procedures will continue to grow in the 21st century.
