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Ambulatory Anesthesia

The Ambulatory Anesthesia rotation provides residents with an opportunity to acquire a set of skills necessary to appropriately care for patients having ambulatory surgery, or surgery where patients are discharged to their home the same day. These skills are distinctly different from the traditional model of inpatient evaluation.

Patient Care/Education

Current trends in healthcare in the United States show a progressive shift towards ambulatory surgery. In 2010, Dartmouth-Hitchcock Medical Center opened an Outpatient Surgery Center (OSC) to aid in its mission to provide our patients with “the right care, in the right place, at the right time, every time.” Ambulatory surgery can occur either at the OSC or the main hospital. Currently 57% of all surgery patients go home the same day, and this percentage is expected to increase.

In the ambulatory setting, it is critical to promote efficient care without compromising patient safety. While the great majority of surgeries are appropriate for same day discharge and to be performed at our OSC, certain surgeries, like airway surgery, are not appropriate. In order to optimize patient safety, a preoperatively evaluation of the patient is done by the anesthesiologist, days to weeks prior to the surgery, to determine if he or she is an appropriate candidate for ambulatory surgery, as if so, at OSC, the main hospital, or neither. Sometimes, the patient is in fact eligible for ambulatory surgery but must have the procedure at the main hospital due to the need for specialized equipment or a higher chance of admission due to surgical or patient factors.

Regardless of location, on the day of surgery, the anesthesiology team again performs a comprehensive review of the patient’s medical history, a physical examination and gathers any necessary further information in order to formulate and implement an anesthetic care plan. When having same day surgery, this plan often focuses on nausea and vomiting prevention, rapidly acting drugs that are metabolized quickly, regional anesthesia, and / or non-opioid techniques for controlling pain. After surgery, the anesthesiology team follows the patient through the recovery process to achieve a safe discharge to home. The perioperative nursing team is also crucial during this process, particularly for providing patient education and for anticipating difficulties at home after discharge. Skillful implementation of this paradigm allows the ambulatory anesthesiologist to avoid problems such as patient dissatisfaction, inefficient operating room utilization, unexpected surgery cancellations, unplanned inpatient admission and unexpected adverse anesthetic outcomes.