Ambulatory Anesthesia

Ambulatory anesthesia is used for surgical procedures where the patient does not need to stay overnight in the hospital. The same anesthetics that are used in the operating room setting are used in the ambulatory setting, including general, regional and local anesthetics. Sedation anesthetics are also given in the ambulatory setting.

At the UC Davis Medical Center, the majority of ambulatory anesthetics are scheduled for the Same Day Surgery Center.

In outpatient clinics, your primary physician is an anesthesiologist. It is this person who will supervise your visit from entering the center to your release at the end of your operation and successful recovery.

The first ether anesthetic in the United States was given for ambulatory surgery. The patient, James M. Venable, had a small cystic tumor removed from the back of his neck by Dr. Crawford W. Long on the evening of March 30, 1842 after school was dismissed.

It was an anesthesiologist who developed this form of surgery outside the hospital setting for procedures that were deemed safe to perform in an ambulatory setting. The amount of surgery performed in outpatient clinics for the past 26 years attests to the safety and effectiveness of this setting for medical operations.

As the quality of surgery and the safety of anesthesia improves, we find that ambulatory surgery can be performed in patients with multiple medical problems. Your problems should be stable. Ask your anesthesiologist to be certain.

Common side effects after ambulatory surgery include nausea, vomiting, headache, sore throat, pain not related to the incision, dizziness, shivering and drowsiness for at least 24 hours. These side effects should be discussed with your anesthesiologist and/or surgeon. Certain drugs can be administered to help minimize these side effects. You should not drive, operate power tools, or be involved in major business decisions for at least 24 hours after a procedure.

Appropriate procedures for ambulatory surgery are those associated with postoperative care that is easily managed at home, and with low rates of postoperative complications that require intensive physician or nursing management. Lists of ambulatory procedures quickly become outdated simply because they exclude certain procedures which in a short time may become routine in ambulatory settings. Length of surgery is not a criterion for ambulatory procedures because there is little relationship between length of anesthesia and recovery.

Ambulatory surgery occurs in a variety of settings. Some centers are within a hospital or in a freestanding satellite facility that is either part of or independent of a hospital. Physicians' offices may also serve as locations for these procedures.

Sometimes called ambulatory anesthesia, special medications and techniques are used when a patient is expected to go home as soon as possible on the same day of the surgery. Office-based surgery, thus, is a form of ambulatory anesthesia.

Since most patients want to avoid an overnight hospital stay after surgery, ambulatory surgical procedures have become very popular. That's why almost one-half of all surgeries are now being done in an outpatient facility, either connected to a hospital or in a separate surgical center. More recently, though, there has been a growing trend for surgery to be done right in a doctor's office. Office-based surgery can offer the convenience of having a procedure done in a more comfortable setting and with a quick return home.

The same anesthetic techniques used in hospitals and ambulatory surgical centers are used in office-based surgery. They include:

• Local Anesthesia, which provides numbness to a small area of the body, such as a dermatologist might use to numb the skin around a mole before removing it.
• Monitored Anesthesia, (Sedation/Analgesia), during which a patient receives medications that relieve pain and make the patient drowsy. During surgery, the patient's vital signs, including heart rate, blood pressure and oxygen level, will be watched closely in order to avoid sudden changes or complications.
• Regional Anesthesia, which can include spinal blocks, epidural blocks or extremity blocks. Spinal and epidural blocks involve interrupting sensation from the legs or abdomen by injecting local anesthetic medication in or near the spinal canal. Other blocks can be performed for surgery on your extremities, or limbs, blocking sensations from the arm or leg.
• General Anesthesia, which involves the total loss of consciousness, pain sensation and protective airway responses.

Procedures include dental, general surgery, neurosurgery, orthopedic surgery, pediatric, urology, ENT, gynecology, ophthalmology, pain clinic patients, sports medicine and plastic surgery.

Robin Aldwinckle, B.M.B.S., F.R.C.A.
Professor
Same Day Surgery Center Medical Director