This chapter primarily describes the typical adult patient undergoing intermediate extensive surgery under general anesthesia at an Ambulatory Surgery Center (ASC). It also provides basic principles for creating a successful ambulatory anesthetic. Most ASCs have different methods of obtaining preoperative information and providing instructions to their patients. To provide a safe anesthetic the following information is required: 1. Preoperative health information including a past medical history (coexisting medical illnesses, concurrent medical problems), relevant surgical history, and history of problems in the perioperative period. 2. Some ASCs have criteria to exclude patients based on their state requirements and their individual capabilities; for example, some ASCs have a BMI limit due to equipment and safety constraints. Other ASCs have limitations on the duration of the surgical procedure or length of recovery room stay depending on their state requirements. 3. Any language barriers and need for interpreter services. 4. Whether the patient will have a responsible adult with them on the day of surgery, to transport them to their residence, receive postoperative instructions, and take care of them for at least the first 24 hours following surgery, when the residual effects of the anesthetic drugs may still be present. 5. Any required preoperative testing is ordered and its results reported to the anesthesiologists prior to surgery. All of the above information can be collected prior to the day of surgery (DOS) either via a phone interview or filled out by the patient on the internet via a questionnaire (secure patient portal) or on the DOS (in person upon arrival to the ASC). A disadvantage of collecting the information on the DOS is the potential for last-minute cancellations. Collecting all of the above information will help exclude patients who are not suitable candidates for ambulatory surgery. Pre-admission testing (PAT) Most ambulatory surgical procedures tend to be low to intermediate risk. Patients are usually ASA 1–2 with some exceptions. Preoperative testing is therefore unnecessary in the vast majority of patients and procedures. An otherwise healthy patient undergoing an intermediate-risk procedure requires no preoperative testing. Women in the reproductive age group (who have not had a tubal ligation or hysterectomy) would require a urine pregnancy test on the day of surgery.
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