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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General anesthesia is the most common form of anesthetic management for ambulatory surgery. Patients, in general, prefer general anesthesia because it is less anxiety provoking. During the last decade, the availability of several short-acting agents with high clearance has made general anesthetic techniques much safer and more predictable for outpatients. ⋯ The introduction of several new agents (e.g., propofol, desflurane, vecuronium, atracurium, mivacurium, rocuronium, alfentanil, ondansetron, ketorolac) has made ambulatory general anesthesia less challenging and more interesting. In the future, the new anesthetic sevoflurane, and the new opioid remifentanil, may prove useful for ambulatory anesthesia. The LMA has all but revolutionized airway management during general anesthesia for ambulatory surgery.