Ambulatory Anesthesia Advances into the New Millennium

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Abstract
Ecent advances in anesthetic and surgical prac- tices have facilitated the rapid growth in ambu- latory surgery throughout the world. With the availability of rapid, short-acting anesthetic, analgesic, sympatholytic, and muscle relaxant drugs, as well as improved monitoring devices, it has been possible to minimize the adverse effects of anesthesia on the re- covery process. Improvements in the perioperative care of outpatients has allowed surgeons to perform an increasing array of more invasive surgical proce- dures on an ambulatory (day-case) basis. Major ambulatory surgery procedures (e.g., exten- sive knee and shoulder reconstructions, laparoscopic- assisted vaginal hysterectomies, gastric fundoplica- tions, splenectomies, and adrenalectomies) are being performed at many centers around the world. Even patients undergoing carotid endarterectomy, pulmo- nary lobectomy, prostatectomy, and minor craniec- tomy procedures are being discharged on a same-day (or 23-hour admit) basis. Although it is commonly assumed that the primary reason for the continued expansion in ambulatory surgery is related to pressure from third-party payors and governmental agencies to reduce health care costs, there may be other, less ob- vious, benefits for patients and their families (1). More aggressive rehabilitation leads to faster recovery of organ function, fewer surgical and anesthetic compli- cations, reduced mental and physical disability, and, most importantly, earlier resumption of normal activ- ities. For patients "at risk" of hospital-acquired infec- tions (e.g., immunosuppressed patients), ambulatory surgery may also reduce postoperative infectious complications.