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Ambulatory Anesthesia

Fast, safe, same-day discharge.

Ambulatory anesthesia prioritizes rapid emergence, minimal PONV, effective analgesia, and quick discharge readiness. Patient selection, multimodal opioid-sparing analgesia, and PONV prophylaxis are the pillars.

Key concepts

Patient selection

ASA I–III stable. OSA — risk-stratify with STOP-BANG. Most BMI <40 acceptable. Frailty matters more than age.

Drug selection

Short-acting agents: propofol, sevo/desflurane, remifentanil, sugammadex.

PONV prophylaxis

Apfel score-based: 0–1 risk factors → none/single agent; 2 → two agents; 3–4 → multimodal + TIVA + dexamethasone.

Discharge criteria

Aldrete or PADSS score; tolerating PO, voiding (selectively), ambulating, controlled pain & nausea, responsible adult escort.

Monitoring

  • Standard ASA monitors
  • Discharge readiness scores

Common drugs

PropofolSevoflurane/desfluraneRemifentanil/fentanylSugammadexOndansetronDexamethasoneAcetaminophenKetorolac

Clinical pearls

1Avoid long-acting opioids — they undermine your discharge time and create unsafe outpatients.
2Field block / wound infiltration before incision provides hours of analgesia for free.

References & Further Reading

  1. 1
    Journal

    Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology. 1999;91(3):693-700.

  2. 2
    Journal

    Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting (IMPACT). N Engl J Med. 2004;350(24):2441-2451.

  3. 3
    GuidelineOpen source

    American Society of Anesthesiologists. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-393.

  4. 4
    Textbook

    Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.