International anesthesiology clinics
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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.
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Ambulatory anesthesia has become recognized as an anesthetic subspecialty, with formal postgraduate training programs. With increasing clinical experience, it is possible to determine which patients will derive the greatest clinical benefit from ambulatory surgery. Further expansion of the specialty of ambulatory anesthesia and surgery is likely to occur in the near future. ⋯ Increasingly, anesthesia practitioners as well as pharmacy and therapeutic committees are demanding evidence that new drugs and medical devices are superior to existing products--that they work better, have fewer adverse effects, and enhance efficiency, thereby reducing healthcare costs. As new biomedical technology is introduced to facilitate the perioperative management of patients (e.g., computerized anesthesia information management systems), evidence that these systems enhance our ability to provide high-quality, cost-effective health care will assume greater importance. The challenge that all practitioners face is to provide high-quality ambulatory anesthesia care at a reduced cost.