Abstract
Purpose
Recovery and discharge following ambulatory surgery are important components of the ambulatory surgery experience. This review provides contemporary perspectives on the issues of discharge criteria, fast-tracking, patient escort requirements, and driving after ambulatory anesthesia.
Source
A search was performed in the Cochrane Central Registerfor Controlled Trials, MEDLINE®, EMBASE®, CINAHL, and PsycINFO, to review factors delaying discharge following ambulatory surgery. The following subject headings were used: “ambulatory surgery, discharge, recovery, car driving, escort, transport, fast tracking, patient discharge, recovery, transportation of patients, hospital discharge, recovery room, patient transport, hospital discharge, recovery room, anesthetic recovery, patient transport, ambulatory surgical procedures, patient discharge, recovery of function, automobile driving, patient escort service, recovery room”. Using the same search engines, the following keywords were used: “fast tracking, recovery, and discharge”.
Principal findings
The current literature supports that discharge scoring systems may be useful to guide discharge following ambulatory surgery. While fast-tracking has become common in some centres, further studies are required to justify more routine implementation of this practice in the management of patients undergoing ambulatory surgery. Patients at low risk for urinary retention can be discharged home without voiding. Patients should not drive until at least 24 hr postoperatively.
Conclusions
Ensuring rapid postoperative recovery and safe discharge following ambulatory surgery are important components of the ambulatory surgical program. A clearly defined process should be established for each ambulatory surgical unit to ensure the safe and timely discharge of patients after anesthesia, in accordance with current best evidence.
Résumé
Objectif
La récupération et la sortie, suivant une opération en chirurgie ambulatoire, sont des composantes importantes de la chirurgie d’un jour. La présente revue fournit une nouvelle optique sur les critères de sortie, le mode opératoire rapide, les besoins d’accompagnement et la conduite automobile après une anesthésie ambulatoire.
Source
Une recherche a été réalisée dans le Cochrane Central Register for Controlled Trials, MEDLINE®, EMBASE®, CINAHL et PsycINFO, pour revoir les facteurs qui retardent le départ du service de chirurgie ambulatoire. Les mots-sujets suivants ont été utilisés: «ambulatory surgery, discharge, recovery, car driving, escort, transport, fast tracking, patient discharge, recovery, transportation of patients, hospital discharge, recovery room, patient transport, hospital discharge, recovery room, anesthetic recovery, patient transport, ambulatory surgical procedures, patient discharge, recovery of function, automobile driving, patient escort service, recovery room». Avec les mêmes moteurs de recherches nous avons utilisé: «fast tracking, recovery, and discharge».
Constatations principales
Les publications actuelles appuient le système de notation qui peut aider à décider du moment du départ d’un service de chirurgie ambulatoire. Le mode opératoire rapide est devenu courant dans certains centres, mais de nouvelles études doivent justifier l’application plus fréquente de cette pratique en chirurgie ambulatoire. Les patients à faible risque de rétention urinaire peuvent quitter le service avant une miction. Ils doivent attendre au moins 24 h après l’opération pour conduire une auto.
Conclusion
Garantir une récupération postopératoire rapide et un départ hâtif et sûr après une opération ambulatoire sont des composantes importantes du programme de chirurgie ambulatoire. Un processus clairement défini doit être établi à cet effet.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Marshall SI, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth Analg 1999;88:508–17.
White PF. Bypassing (fast-tracking) of the recovery room after ambulatory surgery. Acta Anaesthesiol Scand 1998; 42:189–91.
Lubarsky DA. Fast-track in the postanesthesia unit: unlimited possibilities? J Clin Anesth 1996; 8(Suppl):S70-S2.
White PF, Ma H, Tang J, Wender RH, Sloninsky A, Kariger R. Does the use of electroencephalographic bispectral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology 2004; 100:811–7.
Song D, van Vlymen J, White PF. Is the bispectral index useful in predicting fast-track eligibility after ambulatory anesthesia with propofol and desflurane? Anesth Analg 1998; 87:1245–8.
Aldrete JA. The post-anesthesia recovery score revisited (Letter). J Clin Anesth 1995; 7:89–91.
White PF, Song D. New criteria for fast-tracking after outpatient anesthesia: a comparison with the modified Aldrete’s scoring system. Anesth Analg 1999; 88:1069–72.
Dexter F, Tinker J. Analysis of strategies to decrease postanesthesia care unit costs. Anesthesiology 1995; 82:94–101.
Dexter F, Macario A, Manberg PJ, Lubarsky DA. Computer simulation to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase I postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center. Anesth Analg 1999; 88:1053–63.
Apfelbaum JL, Walawander CA, Grasela TH, et al. Eliminating intensive postoperative care in same-day surgery patients using short-acting anesthetics. Anesthesiology 2002; 97:66–74.
Williams BA, Kentor ML, Williams JP, et al. PACU bypass after outpatient knee surgery is associated with fewer unplanned hospital admissions but more phase II nursing interventions. Anesthesiology 2002; 97:981–8.
Duncan PG, Shandro J, Bachand R, Ainsworth L. Pilot study of recovery room bypass (“fast-track protocol“) in a community hospital. Can J Anesth 2001;48:630–6.
Song D, Chung F, Ronayne M, Ward B, Yogendran S, Sibbick C. Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery. Br J Anaesth 2004; 93:768–74.
Millar J. Fast-tracking in day surgery. Is your journey to the recovery room really necessary? (Editorial) Br J Anaesth 2004; 93:756–8.
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49:924–34.
Korttila KT. Post-anaesthesia psychomotor and cognitive function. Eur J Anaesthesiol Suppl 1995; 10:43–6.
Chung F, Chan VW, Ong D. A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth 1995; 7:500–6.
Chung F. Recovery pattern and home-readiness after ambulatory surgery. Anesth Analg 1995; 80:896–902.
Marshall S, Chung F. Assessment of ’home-readiness’ - discharge criteria and postdischarge complications. Curr Opin Anesthesiol 1997; 10:445–50.
Newman MG, Trieger N, Miller JC. Measuring recovery from anesthesia: a simple test. Anesth Analg 1969; 48:136–40.
Hannington-Kiff JG. Measurement of recovery from outpatient general anaesthesia with a simple ocular test. Br Med J 1970; 3:132–5.
Korttila K, Tammisto T, Ertama P, Pfaffli P, Blomgren E, Hakkinen S. Recovery, psychomotor skills, and simulated driving after brief inhalational anesthesia with halothane or enflurane combined with nitrous oxide and oxygen. Anesthesiology 1977; 46:20–7.
Craig J, Cooper GM, Sear JW. Recovery from day case anaesthesia. Comparison between methohexi-tone, althesin and etomidate. Br J Anaesth 1982; 54:447–51.
Vickers MD. The measurement of recovery from anaesthesia. Br J Anaesth 1965; 37:296–302.
Reitan JA, Porter W, Braunstein M. Comparison of psychomotor skills and amnesia after induction of anesthesia with midazolam or thiopental. Anesth Analg 1986; 65:933–7.
Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95:461–6.
Lichtor JL, Alessi R, Lane BS. Sleep tendency as a measure of recovery after drugs used for ambulatory surgery. Anesthesiology 2002; 96:878–83.
Ledin T, Gupta A, Tytor M. Postural control after propofol anaesthesia in minor surgery. Acta Otolaryngol Suppl 1995; 520(Pt 2): 313–6.
Schreiner MS, Nicolson SC, Martin T, Whitney L. Should children drink before discharge from day surgery? Anesthesiology 1992; 76: 528–33.
Kearney R, Mack C, Entwistle L. Withholding oral fluids from children undergoing day surgery reduces vomiting. Paediatr Anaesth 1998; 8:331–6.
Jin FL, Norris A, Chung F, Ganeshram T. Should adult patients drink fluids before discharge from ambulatory surgery? Anesth Analg 1998; 87:306–11.
American Society of Anesthesiologists Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: a report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology 2002; 96: 742–52.
Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology 2002; 97:315–9.
Axelsson K, Mollefors K, Olsson JO, Lingardh G, Widman B. Bladder function in spinal anaesthesia. Acta Anaesthesiol Scand 1985; 29:315–21.
Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery. Anesth Analg 1999; 89:90–7.
Rosseland LA, Stubhaug A, Breivik H. Detecting postoperative urinary retention with an ultrasound scanner. Acta Anaesthesiol Scand 2002; 46:279–82.
Kamphuis ET, Ionescu TI, Kuipers PW, de Gier J, van Venrooij GE, Boon TA. Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology 1998; 88:310–6.
Joshi GP. The Society for Ambulatory Anesthesia: 19th Annual Meeting Report. Anesth Analg 2005;100:982–6.
Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg 1998; 87:816–26.
Bryson GL, Chung F, Cox RG, et al.;Canadian Ambulatory Anesthesia Research Education Group. Patient selection in ambulatory anesthesia - an evidence-based review: part II. Can J Anesth 2004; 51:782–94.
Malignant Hyperthermia Association of the United States. Medical Professionals’ FAQs. 2003; available from URL; http://www.mhaus.org/index.cfm/fuse-action/Content.Display/PagePK/MedicalFAQs.cfm.
Malignant Hyperthermia Association of Canada. Elective management of malignant hyperthermia susceptible patients. 2003; available from URL; http://www.mhacanada.org/MHA%20Poster%20txt.pdf.
Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 2005; 101:1634–42.
Reuben SS, Pristas R, Dixon D, Faruqi S, Madabhushi L, Wenner S. The incidence of complex regional pain syndrome after fasciectomy for Dupuytren’s contracture: a prospective observational study of four anesthetic techniques. Anesth Analg 2006; 102:499–503.
Hadzic A, Arliss J, Kerimoglu B, et al. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology 2004; 101:127–32.
Hadzic A, Karaca PE, Hobeika P, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg 2005; 100:976–81.
McCartney CJ, Brull R, Chan VW, et al. Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery. Anesthesiology 2004; 101:461–7.
Hadzic A, Williams BA, Karaca PE, et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology 2005; 102:1001–7.
Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU. Interscalene block for shoulder arthroscopy: comparison with general anaesthesia. Arthroscopy 1993; 9:295–300.
Wu CL, Rouse LM, Chen JM, Miller RJ. Comparison of postoperative pain in patients receiving interscalene block or general anesthesia for shoulder surgery. Orthopedics 2002; 25:45–8.
Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for pain relief after arthroscopic shoulder surgery: a new modality? Anesth Analg 1997; 84:1306–12.
Song D, Greilich NB, White PF, Watcha MF, Tongier WK. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy. Anesth Analg 2000; 91:876–81.
Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet 2003; 362:853–8.
Toivonen J, Permi J, Rosenberg PH. Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia. Acta Anaesthesiol Scand 2001; 45:603–7.
Andersen FH, Nielsen K, Kehlet H. Combined ilioinguinal blockade and local infiltration anaesthesia for groin hernia repair--a double-blind randomized study. Br J Anaesth 2005; 94:520–3.
Tzabar Y, Asbury AJ, Millar K. Cognitive failures after general anaesthesia for day-case surgery. Br J Anaesth 1996; 76:194–7.
Ward B, Imarengiaye C, Peirovy J, Chung F. Cognitive function is minimally impaired after ambulatory surgery. Can J Anesth 2005; 52:1017–21.
Wu CL, Hsu W, Richman JM, Raja SN. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg Anesth Pain Med 2004; 29:257–68.
Tarkilla P, Huhtala J, Tuominen M. Transient radicular irritation after spinal anaesthesia with hyperbaric 5% lignocaine. Br J Anaesth 1995; 74:328–9.
Schneider M, Ettlin T, Kaufmann M, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 1993; 76:1154–7.
Rodriguez-Chinchilla R, Rodriguez-Pont A, Pintanel T, Vidal-Lopez F. Bilateral severe pain at L3-4 after spinal anaesthesia with hyperbaric 5% lignocaine. Br J Anaesth 1996; 76:328–9.
Kouri ME, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers. Anesth Analg 2004; 98:75–80.
Yoos JR, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with small-dose bupivacaine in volunteers. Anesth Analg 2005; 100:566–72.
Ben-David B, Levin H, Solomon E, Admoni H, Vaida S. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg 1996; 83:716–20.
Cappelleri G, Aldegheri G, Danelli G, et al. Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study. Anesth Analg 2005; 101:77–82.
Vaghadia H, McLeod DH, Mitchell GW, Merrick PM, Chilvers CR Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient lapa- roscopy. I. A randomized comparison with conventional dose hypobaric lidocaine. Anesth Analg 1997; 84:59–64.
Pittoni G, Toffoletto F, Calcarella G, Zanette G, Giron GP. Spinal anesthesia in outpatient knee surgery: 22- gauge versus 25-gauge Sprotte needle. Anesth Analg 1995; 81:73–9.
Santanen U, Rautoma P, Luurila H, Erkola O, Pere P. Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache. Acta Anaesthesiol Scand 2004; 48:474–9.
Pflug AE, Aasheim GM, Foster C. Sequence of return of neurological function and criteria for safe ambulation following subarachnoid block (spinal anaesthetic). Can Anaesth Soc J 1978; 25:133–9.
Klein SM, Nielsen KC, Greengrass RA, Warner DS, Martin A, Steele SM. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesth Analg 2002; 94:65–70.
Enneking FK, Chan V, Greger J, Hadzic A, Lang SA, Horlocker TT. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med 2005; 30:4–35.
Warner MA, Sheilds SE, Chute CG. Major morbidity and mortality within 1 month of ambulatory surgery and anaesthesia. JAMA 1993; 270:1437–41.
Claxton AR, McGuire G, Chung F, Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth Analg 1997; 84:509–14.
Nielsen KC, Tucker MS, Steele SM. Outcomes after regional anesthesia. Int Anesthesiol Clin 2005; 43:91–110.
Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg 1999; 89:1352–9.
Junger A, Klasen J, Benson M, et al. Factors determining length of stay of surgical day-case patients. Eur J Anaesthesiol 2001; 18:314–21.
Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997; 85:808–16.
Shaikh S, Chung F, Imarengiaye C, Yung D, Bernstein M. Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy. Can J Anesth 2003; 50:514–8.
Wilson AT, Nicholson E, Burton L, Wild C. Analgesia for day-case shoulder surgery. Br J Anaesth 2004; 92:414–5.
Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg 2002; 95:627–34.
Jenkins K, Grady D, Wong J, Correa R, Armanious S, Chung F. Post-operative recovery: day surgery patients’ preferences. Br J Anaesth 2001; 86:272–4.
Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89:652–8
Gan TJ. Postoperative nausea and vomiting: can it be eliminated? JAMA 2002; 287: 1233–6.
Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm 2005; 62:1247–60.
Gan T, Sloan F, Dear Gde L, El-Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg 2001; 92: 393–400.
Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693–700.
Apfel CC, Kranke P, Eberhart LH, Roos A, Roewer N. Comparison of predictive models for postoperative nausea and vomiting. Br J Anaesth 2002; 88:234–40.
Koivuranta M, Laara E, Snare L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia 1997; 52:443–9.
Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002; 88:582–4.
Yogendran S, Asokumar B, Cheng DC, Chung F. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995; 80:682–6.
Magner JJ, McCaul C, Carton E, Gardiner J, Buggy D. Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg-1. Br J Anaesth 2004; 93:381–5.
Wu CL, Berenholtz SM, Pronovost PJ, Fleisher LA. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology 2002;96:994–1003.
Jain NB, Pietrobon R, Guller U, Ahluwalia AS, Higgins LD. Influence of provider volume on length of stay, operating room time, and discharge status for rotator cuff repair. J Shoulder Elbow Surg 2005; 14:407–13.
Imasogie N, Chung F. Effect of return hospital visits on economics of ambulatory surgery. Curr Opin Anaesthesiol 2001; 14:573–8.
Gold BS, Kitz DS, LeckyJH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262:3008–10.
Osborne GA, Rudkin GE. Outcome after day-care surgery in a major teaching hospital. Anaesth Intensive Care 1993; 21:822–7.
Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery- a prospective study. Can J Anaesth 1998; 45:612–9.
Awad IT, Moore M, Rushe C, Elburki A, O’Brien K, Warde D. Unplanned hospital admission in children undergoing day-case surgery. Eur J Anaesthesiol 2004; 21:379–83.
Lau H, Brooks DC. Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy. Arch Surg 2001; 136:1150–3.
Lee der PC, Matthews T, Krzeminska K, Dehn TC. Routine day-case laparoscopic cholecystectomy. Br J Surg 2004; 91:312–6.
Robinson TN, Biffl WL, Moore EE, Heimbach JK, Calkins CM, Burch JM. Predicting failure of outpatient laparoscopic cholecystectomy. Am J Surg 2002;184:515–9.
Ganesan S, Prior AJ, Rubin JS. Unexpected overnight admissions following day-case surgery: an analysis of a dedicated ENT day care unit. Ann R Coll Surg Engl 2000; 82:327–30.
Dornhoffer J, Manning L. Unplanned admissions following outpatient otologic surgery: the University of Arkansas experience. Ear Nose Throat J 2000; 79:710, 713–7.
Cohen MS, Finkelstein SE, Brunt LM, et al. Outpatient minimally invasive parathyroidectomy using local/regional anesthesia: a safe and effective operative approach for selected patients. Surgery 2005; 138:681–7.
Mezei G, Chung F. Return hospital visits and hospital readmissions after ambulatory surgery. Ann Surg 1999; 230:721–7.
Twersky R, Fishman D, Homel P. What happens after discharge? Return hospital visits after ambulatory surgery. Anesth Analg 1997; 84: 319–24.
Lemo P. Development of clinical indicators for ambulatory surgery. Euroanaesthesia refresher course 2005 Vienna, Austria 28–31 May 2005; available from URL; http://www.euroanesthesia.org/education/rc2005vienna/2RC2.pdf.
Fleisher LA, Pasternak LR, Herbert R, Anderson GF. Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care. Arch Surg 2004; 139:67–72.
Coley KC, Williams BA, DaPos SV, Chen C, Smith RB. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anesth 2002; 14:349–53.
Vaghadia H, Scheepers L, Merrick PM. Readmission for bleeding after outpatient surgery. Can J Anaesth 1998; 45:1079–83.
Chung F, Lane R, Spraggs C, et al. Ondansetron is more effective than metoclopramide for the treatment of opioid-induced emesis in post-surgical adult patients. Ondansetron OIE Post-Surgical Study Group. Eur J Anaesthesiol 1999; 16:669–77.
Laffey JG, Carroll M, Donnelly N, Boylan JF. Instructions for ambulatory surgery-patient compre hension and compliance. Ir J Med Sci 1998; 167:160–3.
Zvara DA, Mathes DD, Brooker RF, McKinley CA. Video as a patient teaching tool: does it add to the preoperative anesthetic visit? Anesth Analg 1996; 82:1065–8.
Chew LD, Bradley KA, Flum DR, Cornia PB, Koepsell TD. The impact of low health literacy on surgical practice. Am J Surg 2004; 188:250–3.
Day Surgery - revised edition 2005. Association of Anaesthetists of Great Britain and Ireland. Available from URL; http://www.aagbi.org/pdf/DaySurgery 2.pdf.
Apfelbaum JL, Lichtor JL, Lane BS, Coalson DW, Korttila KT. Awakening, clinical recovery, and psychomotor effects after desflurane and propofol anesthesia. Anesth Analg 1996; 83:721–5.
Sinclair DR, Chung F, Smiley A. General anesthesia does not impair simulator driving skills in volunteers in the immediate recovery period - a pilot study. Can J Anesth 2003; 50:238–45.
Chung F, Imasogie N, Ho J, Ning X, Prabhu A, Curti B. Frequency and implications of ambulatory surgery without a patient escort. Can J Anesth 2005; 52:1022–6.
Korttila K, Linnoila M, Er tama P, Hakkinen S. Recovery and simulated driving after intravenous anesthesia with thiopental, methohexital, propanidid, or alphadione. Anesthesiology 1975; 43:291–9.
Chung F, Kayumov L, Sinclair DR, Edward R, Moller HJ, Shapiro CM. What Is the Driving Performance of Ambulatory Surgical Patients after General Anesthesia? Anesthesiology 2005; 103: 951–6.
Rasmussen LS, Larsen K, Houx P, Skovgaard LT, Hanning CD, Moller JT;The International Study of Postoperative Cognitive Dysfunction. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand 2001; 45:275–89.
Miller LS, Rohling ML. A statistical interpretative method for neuropsychological test data. Neuropsychol Rev 2001; 11:143–69.
Author information
Authors and Affiliations
Corresponding author
Additional information
Competing interests: None declared.
Rights and permissions
About this article
Cite this article
Awad, I.T., Chung, F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anesth 53, 858–872 (2006). https://doi.org/10.1007/BF03022828
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03022828