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Patient selection in ambulatory anesthesia – An evidence-based review: part II

[La sélection des patients en anesthésie ambulatoire – Une revue factuelle : partie II]

Gregory L. Bryson, MD FRCPC MSc^*, Frances Chung, MB FRCPC, Robin G. Cox, MB BS FRCA FRCPC, Marie-Josée Crowe, MD FRCP, John Fuller, MD FRCPC^¶, Cynthia Henderson, MD FRCPC^||, Barry A. Finegan, MB FRCPC^**, Zeev Friedman, MD, Donald R. Miller, MD FRCPC^* and Janet van Vlymen, MD FRCPC for the Canadian Ambulatory Anesthesia Research Education (CAARE) Group

^* From the Department of Anesthesiology, The Ottawa Hospital, Ottawa, Ontario;
Department of Anesthesia, Toronto Western Hospital, Toronto; Ontario;
Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta;
Département d’Anesthésiologie, Hôpital Ste-Justine, Montréal, Québec;
^¶ Department of Anesthesia and Perioperative Care, St. Joseph’s Health Care, London, Ontario;
^|| Department of Anesthesia, Vancouver General Hospital, Vancouver, British Columbia;
^** Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta;
^** Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario;
Department of Anesthesiology, Kingston General Hospital, Kingston, Ontario, Canada.

Address correspondence to: Dr. Gregory L Bryson, Department of Anesthesiology, Head, Pre-Admission Units, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. Phone: 613-761-4169; Fax: 613-761-5209; E-mail:glbryson{at}ottawahospital.on.ca

Purpose: This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors.

Source: Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I.

Principal findings: Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is > 60 weeks and hematocrit is > 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirect-acting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided.

Conclusion: Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management.

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