Patient selection in ambulatory anesthesia - an evidence-based review: part II.
OBJECTIVE
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.


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


RESULTS
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.


CONCLUSIONS
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.
Department of Anesthesiology, Head, Pre-Admission Units, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. glbryson@ottawahospital.on.ca
Gregory L
GL
Bryson
Frances
F
Chung
Robin G
RG
Cox
Marie-Josée
MJ
Crowe
John
J
Fuller
Cynthia
C
Henderson
Barry A
BA
Finegan
Zeev
Z
Friedman
Donald R
DR
Miller
Janet
J
van Vlymen
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000592:standards*; D000758:Anesthesia / Q000009:adverse effects*; D000776:Anesthesiology / Q000592:standards*; D002675:Child, Preschool; D003920:Diabetes Mellitus; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D008297:Male; D008305:Malignant Hyperthermia / Q000150:complications; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects; D009767:Obesity, Morbid / Q000150:complications; D018579:Patient Selection; D012141:Respiratory Tract Infections / Q000150:complications
D008996:Monoamine Oxidase Inhibitors