Anesthesia Outside the Operating Room

摘要

In the 1840s, anesthesia was administered in the office setting by the hands of Crawford Long, Horace Wells, and William Morton.1 Sixty years later in England, James Nicoll documented the successful administration of 8988 ambulatory anesthetics over a 10-year period from 1899-1908. Many others also published their clinical experience with the use of ambulatory anesthesia. Although successful, this period of ambulatory anesthesia faded away and was replaced by traditional inpatient surgery. For about 6 decades, most surgeries, as most anesthetics, were performed in the inpatient setting. In the 1960s, expanding medical knowledge and expertise, combined with increased health care costs, led to a renewed interest in outpatient care of the surgical patient. Over the next 4 decades, the use of ambulatory anesthesia grew dramatically and is currently estimated to be used in more than 70% of all surgical cases. Better medications and important clinical and technological developments in medicine, in general, and in the field of anesthesia, in particular, are major contributors facilitating the shift from inpatient to ambulatory anesthetic care. This chapter will examine the trends in this field that make it possible to safely conduct a wide range of procedures in patients who would have been very poor candidates for surgical interventions outside the operating room (OR) just a few years back.