Today, the majority of patients who undergo surgery or diagnostic tests do not need to stay overnight in the hospital. In most cases, you will be well enough to complete your recovery at home. Ambulatory, or outpatient anesthesia and surgical care have proven to be safe, convenient, and cost-effective. Procedures may be performed in a variety of facilities: hospital, freestanding surgery center, or even a surgeon's office. Whatever the facility, your anesthesia will be administered or supervised by an anesthesiologist.

What is ambulatory anesthesia?
Ambulatory anesthesia is tailored to meet the needs of ambulatory surgery so that you can go home soon after your operation. Short-acting anesthetic drugs and specialized techniques, as well as care specifically focused on the needs of the ambulatory patient are intended to make the experience safe and as pleasant as possible. Because each patient is unique, your anesthesiologist will carefully evaluate you to determine if you are a good candidate for ambulatory anesthesia. If you are in reasonably good health, you will most likely be cleared to proceed.

When will I meet my anesthesiologist?
Your anesthesiologist or an associate will interview you before your surgery to gather the necessary information to evaluate your general health. This interview may take place in a telephone call, a visit to the surgical facility, or the anesthesiologist's office. The anesthesiologist will review your medical, surgical, and anesthetic records, and may order lab tests to check blood or other health factors that don't show up in a physical exam. You may be asked to fill out a questionnaire about your previous anesthetic experiences, as well as any medical conditions or allergies you have and any medications or herbal supplements you're taking. If you have particular concerns about anesthesia, this is the time to discuss them.

What types of anesthesia are available?
Selecting the best anesthetic for your procedure will be based on several factors. One is the type of procedure you're having. Another is your medical history. For outpatient surgery, some techniques will allow a faster recovery with fewer side effects. And finally, your preferences will be taken into account.

There are four anesthetic options:

•  General anesthesia
This produces unconsciousness so that you will not feel, see, or hear anything during the surgical procedure. The anesthetic medications are given to you through either an intravenous line or an anesthesia mask.

•  Regional anesthesia
This technique produces numbness by injecting local anesthesia around the nerves in the region of the body where the surgery will be performed. An epidural or spinal block anesthetizes the abdomen and lower extremities. Other nerve blocks may be used to anesthetize one or both arms or legs. With regional anesthesia, you may also be given medications that will make you drowsy and blur your memory.

•  Monitored anesthesia
With this approach, your anesthesiologist gives you sedatives and pain medication through your intravenous line. The surgeon or anesthesiologist will also inject local anesthesia into the skin in the area of your surgery, for additional pain control during and after the procedure. While you are sedated, your anesthesiologist will monitor your vital body functions.

•  Local anesthesia
Here, anesthesia is injected to numb the surgical site. It may be administered by your surgeon rather than by a member of your anesthesia team.

Before receiving any type of anesthesia your anesthesiologist will discuss the risks and benefits associated with each option. Sometimes it is not possible to keep you comfortable with regional, monitored, or local anesthesia, and general anesthesia is required. Side effects, though rare, can occur with any type of anesthesia, so you will want to ask what precautions will be taken to avoid them.

Before the Surgery

What about eating or drinking before anesthesia?
As a general rule, you should not eat or drink anything after midnight of the evening before your surgery. Under some circumstances, you may be given permission to drink clear liquids up to a few hours before your anesthesia. Smoking affects blood clotting. If you smoke, try to stop well in advance of any surgical procedure. In any case, do not smoke after midnight before your surgery.

Will I need someone to take me home?
You must make arrangements for a responsible adult to take you home after your anesthetic or sedation. Most surgical facilities will not let you leave alone or drive yourself home. (In some cases, if you have local anesthesia with no sedation, you may be able to go home unaccompanied, but be sure to check with your doctor in advance.) It is strongly recommended that you have someone stay with you during the first 24 hours after surgery. If you do not have anyone at home to help, you may need to make other arrangements. Some ambulatory facilities offer special post-surgical recovery facilities or extended services with nurses who visit you at home.

These instructions are important for your safety. If you do not follow your physician's instructions about not eating before the procedure, or arranging for an adult to take you home, your surgery may be canceled.

Should I take my usual medicines before surgery?
Some medications should be taken and others should not. Discuss this with your anesthesiologist. Do not interrupt medications unless your anesthesiologist or surgeon recommends it.

What should I wear for surgery?
Depending on the procedure, you may be given a hospital gown to wear during the surgery. Be sure to have loose-fitting clothes to wear home that are easy to put on and will fit over bulky bandages or surgical dressings. Don't bring jewelry or valuables to the surgical facility.

Day of Surgery

What happens before my surgery?
Your anesthesiologist and surgeon will visit with you, completing any evaluations and reviewing the results of any laboratory tests, as well as answering any further questions you have. A nurse will record your vital signs, then intravenous fluids will be started, and if needed, you will be given a sedative or other preoperative medications. Once you enter the operating room, you will be hooked up to various monitoring devices, including a blood pressure cuff and an EKG (electrocardiogram). At that point, you will be ready for anesthesia.

What happens during my surgery?
Your anesthesiologist is personally responsible for your comfort and well-being during your operation, and leads the anesthesia care team in monitoring and managing your vital body functions throughout the procedure. The anesthesiologist is also responsible for managing any medical problems that might arise during the surgery, as well as any chronic conditions you may have, such as asthma, diabetes, high blood pressure, or heart problems. A member of your anesthesia team will be with you throughout your surgery.

Recovery in the Surgical Facility

What can I expect after the operation?
After surgery, you will be taken to the post-anesthesia care unit, often called the recovery room. Your anesthesiologist will direct the monitoring and medications needed for your safe recovery. For the first thirty minutes or so, you will be watched closely by specially trained nurses. During this period, you may be given extra oxygen, and your breathing and heart functions will be observed. In some facilities, you may then be moved to another area to complete your recovery. Family or friends may be allowed to stay with you there. The nursing staff in this area will assist you when you are ready to go home.

Will I have any side effects?
The amount of postoperative discomfort you experience will depend on a number of factors, especially the type of surgery. Your doctors and nurses can relieve pain after the surgery with medicines given by mouth or injection, or by numbing the area around the incision. Your discomfort should be tolerable, but do not expect to be totally pain free. You may experience some nausea or vomiting related to the anesthesia, the surgical procedure itself, or postoperative pain medications. Your anesthesiologist may give you medications during the surgery or recovery period to minimize side effects.

When will I be able to go home?
That will depend on the type of surgery and anesthesia you had, and the policy of the surgery center. Most patients are ready to leave between one and four hours after surgery. Very occasionally, you may need to stay overnight. All ambulatory surgical facilities have arrangements with a hospital if an overnight stay becomes necessary.

What instructions will I receive before I go home?
Most likely you will be given both verbal and written instructions about your aftercare. Usually you'll be advised to observe the following for 24 hours after anesthesia:

• Do not drink alcoholic beverages or use non-prescription medications.
• Do not drive a car or operate dangerous machinery.
• Do not make important decisions.

Before you leave the surgical facility, make sure you are given telephone numbers to call if you have any concerns after the surgery or you need emergency help.

Recovery at Home

What can I expect once I leave the surgical facility?
Be prepared to go home and finish your recovery there. Following ambulatory anesthesia, patients often experience drowsiness and minor aftereffects, including muscle aches, sore throat, occasional dizziness, headaches, and nausea. These side effects usually decline rapidly in the hours following surgery, but it may take several days before they are gone completely. The majority of patients do not feel up to their typical activities the day after surgery. Tiredness and some surgical discomfort are common. Plan to take it easy for a few days until you feel back to normal.

What kind of follow-up will there be?
Be sure to follow the instructions given to you about your postoperative care. This is important to permit the fastest, safest, and most comfortable recovery possible. Usually within 24 hours of your ambulatory anesthesia and surgery, you will receive a call from your surgeon or anesthesiologist or one of their staff members to see how you feel. (You're instructed to call your physician immediately if you have any problems post-surgery.) Some time later you may receive a follow-up call from the surgical facility, or a written questionnaire asking for feedback on your experience. Use this opportunity to let your caregivers know how you feel so they may provide the best possible care.

Patient's Rights

What are my rights as a patient?
Even if you are not spending the night in a hospital, you are still a patient and entitled to the same rights that hospitalized patients receive. Before the surgery, you should be given an opportunity to speak to those who will be involved in your anesthesia care. All questions involving how the anesthesia will be administered, and the training and qualifications of those providing your anesthesia, should be answered fully. Any concerns you have about the facility, billing, pain management, or safety equipment should be addressed to your satisfaction before you undergo anesthesia. The professionals caring for you should treat you ethically and respect your privacy and dignity. If you feel uncomfortable about any aspect of your care, you have the right to refuse the planned treatment.

What if I have other questions?
Ask questions at any stage of the process. Your experience of anesthesia and surgery will be easier if you know what to expect. Remember: The focus of the procedure is you, the patient.