title: Perioperative care for the older outpatient undergoing ambulatory surgery.
abstract: As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly will assume increased importance. Given the recent advances in anesthesia, surgery, and monitoring technology, the ambulatory setting offers potential advantages for elderly patients undergoing elective surgery. In this review article we summarize the physiologic and pharmacologic effects of aging and their influence on anesthetic drugs, the important considerations in the preoperative evaluation of elderly outpatients with coexisting diseases, the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and offer recommendations regarding the management of common postoperative side effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. We conclude with a discussion of future challenges related to the growth of ambulatory surgery practice in this segment of our surgical population. When information specifically for the elderly population was not available in the peer-reviewed literature, we drew from relevant information in other ambulatory surgery populations.
authors.affiliation: Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, California, USA. whitemountaininstitute@hotmail.com
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.forename: Lisa M
authors.initials: LM
authors.lastname: White
authors.forename: Terri
authors.initials: T
authors.lastname: Monk
authors.forename: Jan
authors.initials: J
authors.lastname: Jakobsson
authors.forename: Johan
authors.initials: J
authors.lastname: Raeder
authors.forename: Michael F
authors.initials: MF
authors.lastname: Mulroy
authors.forename: Laura
authors.initials: L
authors.lastname: Bertini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Torri
authors.forename: Maurizio
authors.initials: M
authors.lastname: Solca
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pittoni
authors.forename: Gabriella
authors.initials: G
authors.lastname: Bettelli
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000553:Ambulatory Care; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D015897:Comorbidity; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome